Obstetrics and Gynaecology

Question 1

define fibroids

Answer 1

benign tumours of the myometrium

Question 2

fibroids risk factors

Answer 2

more common near menopause
early puberty
family history
more common in people of Afro-Caribbean descent

Question 3

protective factors for fibroids

Answer 3

parous women
women who have taken COCP
late puberty

Question 4

name the sites of fibroids

Answer 4

Subserosal
Intramural
Submucosal

Question 5

symptoms of fibroids

Answer 5

menorrhagia, intermenstrual bleeding, frequency/urgency, infertility, dysmenorrheoa

Question 6

complications of fibroids

Answer 6

torsion, malignancy, degeneration

Question 7

pregnancy complications of fibroids

Answer 7

premature labour
malpresentations
transverse lie
obstructed labour
postpartum haemorrhage
red degeneration

Question 8

fibroid investigations

Answer 8

abdominal/pelvic examination
ultrasound scan - transvaginal and transabdominal
Hysteroscopy
FBC - low if heavy bleeding, may be high as fibroids secrete erythropoietin

Question 9

management of fibroids

Answer 9

None if asymptomatic/slow growing
Fibroids <3cm = Transexamic acid, NSAIDs, progesterones, IUS, COCP
Fibroids >3cm = Ulipristal acetate
Other = GnRH agonists, mifepristone
Surgical = Hysterectomy, myomectomy, uterine artery embolization

Question 10

define adenomyosis

Answer 10

presence of endometrium in the myometrium

Question 11

symptoms of adenomyosis

Answer 11

asymptomatic, painful regular heavy menstruation

Question 12

signs of adenomyosis

Answer 12

mildly enlarged, tender uterus

Question 13

diagnosis for adenomyosis

Answer 13

MRI

However often diagnosed at histology on hysterectomy

Question 14

treatment for adenomyosis

Answer 14

Medical - Progesterone IUS, COCP +/- NSAIDs, GnRH

Surgical - Hysterectomy

Question 15

Polycystic ovary syndrome diagnostic triad

Answer 15

Polycystic ovaries on USS
Irregular periods
Hirsutism

Question 16

Polycystic ovary syndrome symptoms

Answer 16

obese, acne, excess body hair, oligo- or amenorrhoea, miscarriage

Question 17

investigations for polycystic ovary syndrome

Answer 17

Ultrasound scan - transvaginal
Bloods - Raised LH, raised serum testosterone
High lipids

Question 18

Polycystic ovary syndrome management

Answer 18

Weight loss
COCP
Clomifene or tamoxifen
Metformin

Question 19

Complications of polycystic ovary syndrome

Answer 19

Diabetes mellitus
Gestational diabetes
Endometrial cancer

Question 20

define Endometriosis

Answer 20

Endometrium-like tissue is found outside of the uterus

Question 21

Common sites for endometriosis

Answer 21

Uterosacral ligament, on or behind ovaries

Question 22

Endometriosis symptoms

Answer 22

Pelvic pain, dysmenorrhoea, dyspareunia, dysuria, infertility, fibrosis and adhesions in the pelvis

Question 23

Endometriosis investigations

Answer 23

Physical examination - fixed retroverted uterus & adnexal masses
Laparoscopy and biopsy = GOLD STANDARD
Ultrasound scan
MRI

Question 24

Endometriosis treatment

Answer 24

COCP, GnRH analogues, Danazol

Question 25

Endometriosis treatment

Answer 25

Surgery - destroy lesions

Hysterectomy, Salpingo-oopheroectomy

Question 26

Causes of Pelvic Inflammatory Disease

Answer 26

Due to ascending endocervical infection
Due to descending abdominal infection
Chlamydia
Gonorrhoea

Question 27

Pelvic inflammatory disease symptoms

Answer 27

Pelvic pain, deep dyspareunia, bleeding (intermenstrual, post-coital), discharge due to vaginal `infection

Question 28

Pelvic inflammatory disease investigations

Answer 28

Endocervical swabs for chlamydia and gonorrhoea testing
Ultrasound scan to exclude abscess and ovarian cyst
Antibiotics - IM Ceftriaxone + doxycycline or metronidazole

Question 29

complications of Pelvic inflammatory disease

Answer 29

Subfertility
Chronic PID
Chronic pelvic pain
Ectopic pregnancy

Question 30

Symptoms for chronic pelvic inflammatory disease

Answer 30

Chronic pelvic pain, chronic discharge, heavy and irregular menstruation, infertility

Question 31

Chronic pelvic inflammatory disease investigations

Answer 31

Ultrasound scan, Laparoscopy - reveal adhesions