Obs and Gynae Flashcards
What is dyspareunia? A) pain on urination B) pain associated with menstruation C) pain on defecation D) pain during labour E) pain during sexual intercourse
E) pain during sexual intercourse. May be deep or superficial in nature.
The endometrium is made up of what type of epithelium? A) simple squamous epithelium B) simple columnar epithelium C) simple cuboidal D) pseudostratified columnar E) pseudostratified squamous
B) simple columnar epithelium
The uterus is supported by which 3 ligaments?
Uterosacral, cardinal and round ligaments
What is the name of the structure formed by the peritoneum between the uterus and rectum?
The Pouch of Douglas
What position is the uterus in the majority of women?
Anteverted
An adnexal mass is situated where?
Next to the ovaries
What is the sequence of normal pubertal development in women that ends with menarche?
Breast buds —> growth of pubic hair —> growth of axillary hair —> menarche
At what age might you consider investigations if puberty had not commenced in a girl?
14
At what age might you consider investigations if the menarche had not commenced?
16
Which of the following hormones stimulates the development of a primary follicle within the ovary? A) GnRH B) Oestrogen C) LH D) FSH E) Progesterone
D) FSH
Which of the following hormones stimulates the development of glandular, secretory endometrium and cervical mucous? A) GnRH B) Oestrogen C) LH D) FSH E) Progesterone
B) Oestrogen
Which of the following hormones stimulates ovulation? A) GnRH B) Oestrogen C) LH D) FSH E) Progesterone
C) LH
Which of the following hormones provides negative feedback to the pituitary and reduces FSH secretion? A) GnRH B) Oestrogen C) LH D) FSH E) Progesterone
B) Oestrogen
Which of the following is produced by the corpus luteum? A) GnRH B) Oestrogen C) LH D) FSH E) Progesterone
E) Progesterone
Which TWO of the substances below make up the COCP? A) GnRH B) Oestrogen C) LH D) FSH E) Progesterone
B and E.
How does the COCP prevent ovulation?
The oestrogen prevents the release of FSH and LH from the anterior pituitary via negative feedback. This prevents the maturation of a follicle and the subsequent release of an ovum.
Progesterone has the same effect as it remiains high in pregnancy and prevents further ovulation. It also thickens cervical mucuous and makes it less receptive to sperm.
An overweight 19 year old girl presents with oligomenorrhoea, acne and hirsutism.
A) What is the likely diagnosis?
B) Give two signs/symptoms needed to confirm your diagnosis.
C) What might she be at increased risk of developping in later life?
D) Give two options for managing this patient and the rationale for each.
A) presentation is typical of PCOS
B) two from: USS showing polycystic ovaries, oligoovulation or anovulation, clinical/biochemical signs of hyperandrogenism.
AKA the Rotterdam Criteria
C) Metabolic syndrome, specifically T2DM due to reduced insulin sensitivity with its associated increased risk of CVD
D) - Metformin (to help control the metabolic symptoms and increase insulin sensitivity)
- Weight loss (to increase insulin sensitivity)
- The COCP (to control menstruation and bleeding, important to recommend a withdrawal bleed every 3/12 to reduce risk of endometrial cancer)
- clomifene citrate (increases ovulation if she wants to get pregnant)
Give 3 factors which might pre-dispose a woman to conceiving an ectopic pregnancy.
(Anything which slows the progress of the egg from the ovary to the womb)
Damage to the Fallopian tubes from PID or previous surgery.
Previous ectopic pregnancy
Endometriosis
IUCD
Smoking
An 18 year old woman presents to the A+E department complaining of lower abdominal pain accompanied by vaginal bleeding that has worsened over the last 48 hours. She feels nauseous and on examination you find she is tender over her left iliac fossa and hypogastric region.
A) What is the first diagnosis you must consider in this patient?
B) Apart from an abdominal exam, give three other investigations you should request.
C) Give a medical and surgical treatment option for this patient
A) Ectopic pregnancy
B) FBC, group and save, serum progesterone (to investigate a failing pregnancy) and hCG. Trans-vaginal USS is diagnostic in this case (unless it is a pregnancy of unknown location then need a laparscopy)
C) Methotrexate as a single dose, woman must use contraception for 3/12 afterwards
Laparoscopic removal of the ectopic pregnancy, laparotomy if time is of the essence.
A woman presents with abdominal pain and you request a B-hCG which is found to be 1000. 48 hours later another B-hCG is performed and the level is 1600.
A) What might you suspect and why?
B) A third B-hCG is found to be 2100. What would you expect to see on a TV USS.
A) Ectopic pregnancy. In normal pregnancy the B-hCG should double every 48-72 hours however in an ectopic pregnancy this does not always happen. It is NOT diagnostic but it raises suspicions.
B) at B-hCG levels over 1500 you would expect to be able to see an IUP. However in this woman as she has an ectopic pregnancy you would not find anything.
