Physiology (G)

Question 1

How long is the menstrual cycle?

Answer 1

varies from 21-35 days (usually 28) in length with the variation being in the proliferative phase

Question 2

What are the parts of the ovarian cycle

Answer 2

follicular phase, ovulation and the luteal phase

Question 3

What are the parts of the uterine cycle?

Answer 3

menstrual phase, proliferative phase and secretory phase

Question 4

What are the oestrogen and progesterone levels during the menstrual cycle?

Answer 4

• Oestrogen: goes up in the first half of the cycle in the follicular phase and also peaks less high in the luteal phase
• Progesterone: huge peak in the middle of the luteal phase

Question 5

What hormone surges just prior to ovulation?

Answer 5

LH

Question 6

When does ovulation occur?

Answer 6

after the proliferative phase at day 14

Question 7

What happens in the tissues in the proliferative phase?

Answer 7

endometrial glands and stroma grow

Question 8

What happens in the tissues in the luteal phase?

Answer 8

secretory activity and eventually necrosis

Question 9

What is the normal time length of menstrual loss?

Answer 9

4-6d

Question 10

What is menopause?

Answer 10

12 months of having no periods (perimenopause is irregular periods)

Question 11

What is premature ovarian insufficiency?

Answer 11

starting menopause under the age of 40

Question 12

What is the average age of menopause?

Answer 12

51

Question 13

What are the main symptoms of menopause?

Answer 13

mood swings
night sweats
hot flushes

Question 14

What investigations are done for early menopause?

Answer 14

• between 40 and 45: FSH 6 weeks apart

- under 40: FSH, E2, TFT, glucose, prolactin and FAI

Question 15

What are the lifestyle changes for menopause symptom relief?

Answer 15

• healthy diet and weight
• regular exercise
• no smoking
• good sleep hygiene
• limited alcohol and caffeine
• reduce stress
• CBT

Question 16

What are the other things you can take for menopause?

Answer 16

• HRT

- SSRIs, gabapentin and complementary medicine

Question 17

What are the pros and cons of HRT in the menopause?

Answer 17

• symptom relief with increased QoL particularly for vasomotor symptoms
• can increase breast cancer risk slightly

Question 18

When is HRT for menopause contraindicated?

Answer 18

CVD RF or previous breast ca

Question 19

When is HRT for menopause definitely given?

Answer 19

women with early menopause <40-44

Question 20

When can contraception be stopped after menopause?

Answer 20

• after 2 years of amenorrhoea in 40-49
• 1 year in over 50
• all over 55s

Question 21

What can be used for long-term treatment of vulvo-vaginal atrophy?

Answer 21

local oestrogens

Question 22

What is the most used radiology in gynae?

Answer 22

• US is safe and cheap
• shows the pelvic organs well
• can be used alongside pelvic exam

Question 23

What are the features of TAUS?

Answer 23

• full bladder to provide acoustic window
• safe
• can be difficult for obese patients
• operator dependent

Question 24

What are the features of TVUS?

Answer 24

• higher frequency, shorter wavelength so the transducer needs to be close to target organ due to scattering
• useful in obese patients
• empty bladder
• much better than TA
• not suitable for people who aren’t sexually active
• ovaries can be seen well

Question 25

What are the features of CT in pregnancy?

Answer 25

- should be avoided in women of child bearing age - used for acute pain - assess post-surgical complications - stage malignancy - assess response to chemo/radiotherapy

Question 26

What are the features of MRI in pregnancy?

Answer 26

``` -avoid in first trimester MRI is used for -cancer staging (esp cervical) -evaluation of adnexal and uterine masses -evaluation of subfertility ```

Question 27

What is hysterosalpingography used for?

Answer 27

infertility and provides a live imaging to see if the tubes are patent and can assess the outline of the uterine cavity