Obs

Question 1

What are the types and symptoms of fibroids?

Answer 1

intramural - most fibroids 
submucosal 
subsercosal 
Make periods heavier or longer
Fertility and pregnancy problems - if >5cm into uterine cavity 
pelvic pain

Question 2

What is the treatment of fibroids?

Answer 2

Only treated if symptomatic 
Tranexamic acid, NSAIDs, GnRH agonists 
coil, COCP
Ablation 
Transcervical resection of fibroids

Question 3

What are the tests and treatment for endometrial hyperplasia?

Answer 3

Tests - endometrial biopsy, hysteroscopy, transvaginal US
TREAT - mirena coil, progesterone tablets
Do regular biopsies to monitor progression to carcinoma

Question 4

Why does a high BMI increase risk of endometrial hyperplasia and cancer?

Answer 4

androgens are converted to eostrogen within adipose tissue

Question 5

What are the 2 types of endometrial hyperplasia?

Answer 5

simple - 5% risk of progression to carcinoma in 20 years

Complex with atypia - 28% risk of progression

Question 6

What are the risk factors for endometrial hyperplasia and its symptoms?

Answer 6

RF - BMI >35, high oestrogen, PCOS, tamoxifen, DM, nulliparity
Symptoms - abnormal bleeding e.g. intermenstrual

Question 7

What is the difference in symptoms between endometrial and cervical polyps?

Answer 7

endometrial - intermenstrual bleeding

cervical - mucus discharge, postcoital bleeding

Question 8

What are 3 causes of intermenstrual bleeding?

Answer 8

endometrial or cervical polyps 
PCOS 
tumours 
contraception 
fibroids 
hormone imbalance

Question 9

What is a risk factor of endometriosis polyps and how would you diagnose it?

Answer 9

risk factor - high estrogen e.g. high BMI

hysteroscopy

Question 10

What are the amin symptoms of endometriosis and hwo would you test for it?

Answer 10

chronic pain - cyclic, dyspurinia 
Dysmenorrhea 
infertility 
US, CA125 
only laproscopy is diagnostic

Question 11

What are the main differentials of endometriosis?

Answer 11

adenomysosis - pain
fibroids - pain, infertility, bleeding
endometriosis - pain and infertility

Question 12

What are 3 acute and 3 chronic causes of pelvic pain?

Answer 12

Acute - ectopic pregnancy, miscarriage, ovarian cyst, ascending UTI
Chronic - adenomyosis, endometriosis, fibroids, PID, adhesions, IBS

Question 13

What is criteria for diagnosis of PCOS?

Answer 13

2 of

• oligo/amennorhea
• hyperandrogenism - clinical or biochemical
• polycystic ovaries in US

Question 14

What is it?

Unilateral pelvic pain, vaginal bleeding, cervical excitation, abdominal tenderness, adnexal mass

Answer 14

Ectopic pregnancy

Question 15

How would you test for ectopic pregnancy?

Answer 15

TVUS - empty cavity, extra-adnexal mass, free pelvic fluid, beta hCG increasing, low progesterone

Question 16

What is it?

Vaginal bleeding, clots, abdo cramps, GI upset, abdo tenderness

Answer 16

miscarriage

Question 17

How would you test for miscarriage?

Answer 17

TVUS - no obvious yolk sac, foetal pole or cardiac activity
Doppler - no heartbeat
Beta hCG decreasing

Question 18

What is it?

Early pregnancy, vaginal bleeding, abdo cramps, closed os

Answer 18

subchorionic haemorrhage

Question 19

What is it?

Pelvic girdle pain worsened by movement, clicking or grinding

Answer 19

Symphysis pubis dysfunction

Question 20

How would you test for hyperemesis gravidarum?

Answer 20

inflammatory markers (normal), urinalysis glucose, TFT, PTH, LFT, cortisol, aldosterone

Question 21

What is it?

sudden onset dark bleeding, moderate abdo pain, tender rigid uterus, hypotension

Answer 21

placental abruption

Question 22

What is it?

Sudden onset vaginal bleeding, severe abdo pain, bradycardia, hypotension

Answer 22

Uterine rupture

Question 23

What is it?

Sudden onset bright red vaginal bleeding, can stop spontaneously, soft non-tender abdo

Answer 23

Placenta previa

Question 24

What is it?

Sudden onset vaginal bleeding after ROM, painless

Answer 24

Vasa previa

Question 25

What is it?

Asymptomatic vaginal bleeding in third trimester

Answer 25

placenta accreta

Question 26

What is the peurperal period?

Answer 26

up to 6 weeks post-childbirth

Question 27

What happens to fetal circulation after birth?

Answer 27

RV output increases
decreased venous return
closure of foramen ovale and ductus arterosus