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Year 4: OB-GYN > Questions (Gyne) > Flashcards

Questions (Gyne) Flashcards

1
Q

Which ages do cervical smears occur if they are being repeated every 3 or 5 years? [2]

A

Every 3 years: 25-49

Every 5 years: 50-69

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2
Q

Why do you measure ‘day 21’ progesterone to assess fertility? [1]

A

Serum progesterone testing must be performed 7 days before the end of the menstrual cycle, as a rise in progesterone indicates that the corpus luteum has formed

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3
Q

Describe the treatment options for fibroids to treat

  • menorrhagia [4]
  • to shrink fibroid size [2]
A

Menorrhagia:
- levonorgestrel intrauterine system (LNG-IUS)
- NSAIDs - e.g. mefenamic acid
- tranexamic acid
- combined oral contraceptive pill
- oral progestogen

To shrink fibroids medically:
- GnRH agonists may reduce the size of the fibroid but are typically used more for short-term treatment due to side-effects

To shrink fibroids surgically:
- myomectomy: this may be performed abdominally, laparoscopically or hysteroscopically
- hysteroscopic endometrial ablation
- hysterectomy

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4
Q

The Mirena coil works via which mechanism? [1]

A

Release of progesterone only

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5
Q

What is the aim of HRT? [1]

Describe how you treat menopausal symptoms in a women with a uterus [2]

A

The aim of treating symptoms of menopause is to replace oestrogen (hormone replacement therapy).

However, in a woman with a uterus, an additional source of progesterone is needed to counter the action of unopposed oestrogen on the womb, increasing the risk of endometrial hyperplasia and malignancy.

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6
Q

When is tranexemic vs mefanamic acid indicated for menorrhagia? [2]

A

Painless menorrhagia - Tranexamic acid

PainFul menorrhagia - MeFenamic acid

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7
Q

Woman aged > 30 years with dysmenorrhoea, menorrhagia, enlarged, boggy uterus → [1]

A

Woman aged > 30 years with dysmenorrhoea, menorrhagia, enlarged, boggy uterus → ?adenomyosis

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8
Q

How do you distinguish endometriosis from adenomyosis on TVUS? [2]

A

Adenomyosis:
- enlarged, boggy uterus

Endometriosis:
* A transvaginal scan would either show nothing or would show clumps of tissue (endometrial tissue) growing in places away from the endometrium.

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9
Q

If an incomplete miscarriage has occured - what do you give for medical management? [1]

A

Medical management of an incomplete miscarriage involves giving vaginal misoprostol alone

Don’t need mifepristone if the cervical os is open

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10
Q

[] is associated with a decreased incidence of hyperemesis gravidarum

A

Smoking is associated with a decreased incidence of hyperemesis gravidarum

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11
Q

What is the most significant risk of prescribing an oestrogen-only preparation rather than a combined oestrogen-progestogen preparation for a women with a uterus?

Increased risk of venous thromboembolism
Increased risk of ovarian cancer
Increased risk of endometrial cancer
Increased risk of breast cancer
Increased risk of colorectal cancer

A

What is the most significant risk of prescribing an oestrogen-only preparation rather than a combined oestrogen-progestogen preparation for a women with a uterus?

Increased risk of venous thromboembolism
Increased risk of ovarian cancer
Increased risk of endometrial cancer
Increased risk of breast cancer
Increased risk of colorectal cancer

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12
Q

Ovarian cancer initially spreads by local invasion to where first? [1]
What are the presenting features? [4=

A

Para-aortic lymph nodes
- Older women presenting with vague gastrointestinal symptoms like bloating, early satiety, and weight loss raise suspicion of ovarian cancer.
- Nulliparity, early menarche, and late menopause are additional risk factors. A palpable mass in the left adnexa also suggests ovarian malignancy. Ovarian cancer tends to spread locally first to the para-aortic lymph nodes, which drain the ovaries and fallopian tubes.

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13
Q

Ectopic pregnancy localised to the [] increases the risk of rupture

A

Ectopic pregnancy localised to the isthmus increases the risk of rupture

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14
Q

In patients with urinary incontinence, make sure to rule out [2]

A

In patients with urinary incontinence, make sure to rule out a UTI and diabetes mellitus

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15
Q

A patient suffers from PMS.

What is the treatment ladder for this patient? (mild; moderate; severe) [+]

A

mild symptoms
* can be managed with lifestyle advice
* apart from the usual advice on sleep, exercise, smoking and alcohol, specific advice includes regular, frequent (2-3 hourly), small, balanced meals rich in complex carbohydrates

moderate symptoms
- may benefit from a new-generation combined oral contraceptive pill (COCP) examples include Yasminµ (drospirenone 3 mg and ethinylestradiol 0.030 mg)

severe symptoms
- may benefit from a selective serotonin reuptake inhibitor (SSRI)
- this may be taken continuously or just during the luteal phase (for example days 15-28 of the menstrual cycle, depending on its length)

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16
Q

Name a drug that can be used for N&V during pregnancy but has a limited timespan. What is the timespan and why does this occur? [1]

A

Metoclopramide is an option for nausea and vomiting in pregnancy, but it should not be used for more than 5 days due to the risk of extrapyramidal effects

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17
Q

[] is the drug of choice for medical management of ectopic pregnancy

A

Methotrexate is the drug of choice for medical management of ectopic pregnancy

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18
Q

[Drug class] should be offered as first-line treatment for primary dysmenorrhoea, and [drug] specifically is recommended due to its favourable side effect profile and over-the-counter availability.

A

NSAIDs should be offered as first-line treatment for primary dysmenorrhoea, and ibuprofen specifically is recommended due to its favourable side effect profile and over-the-counter availability.

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19
Q

Women who have been admitted with hyperemesis gravidarum are generally given IV []

A

Women who have been admitted with hyperemesis gravidarum are generally given IV normal saline with added potassium as hypokalaemia is common

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20
Q

A mother attends the GP with her 14-year-old daughter. She is concerned as her daughter has not yet started her periods although suffers cyclical pain. On examination the daughter looks well. What is the most likely diagnosis? [1]

A

the patient appears well but is suffering cyclical pain with no evidence of menstruation:
- imperforate hymen

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21
Q

A women who is 5 weeks pregnant presents with PV bleeding.

She has no history of ectopic pregnancy. On examination, her heart rate is 85 beats per minute, blood pressure is 130/80 mmHg and her abdomen is soft, non-tender.

How do you manage her? [1]

A

Pregnant women who are < 6 weeks gestation and present with vaginal bleeding and no pain can be managed expectantly
- Monitor expectantly and advise to repeat pregnancy test in 7 days. If negative, this confirms miscarriage. If positive, or continued or worsening symptoms, refer to the early pregnancy assessment unit
30%

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22
Q

Infertility in PCOS - [] is typically used first-line

A

Infertility in PCOS - clomifene is typically used first-line

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23
Q

A 76-year-old woman presents with post-menopausal bleeding for the past 4 months. She is diagnosed with well-differentiated adenocarcinoma (stage II) on endometrial biopsy. There is no evidence of metastatic disease. Which is the most appropriate treatment?

Transcervical endometrial resection
Total abdominal hysterectomy
Provera (medroxyprogesterone acetate)
Wertheim’s radical hysterectomy
Total abdominal hysterectomy with bilateral salpingo-oophorectomy

A

Total abdominal hysterectomy with bilateral salpingo-oophorectomy

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24
Q

Older woman with [] and [] → ?vulval carcinoma

A

Older woman with labial lump and inguinal lymphadenopathy → ?vulval carcinoma

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25
Q

A 20-year-old female presents with a 3-month history of abdominal pain. Abdominal ultrasound shows an 8cm mass in the right ovary. Histopathological analysis reveals Rokitansky’s protuberance. What is the most likely diagnosis? [1]

A

Teratomas (dermoid cysts)

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26
Q

Expectant management of an ectopic pregnancy can only be performed for [5]

A

1) An unruptured embryo
2) < 35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of < 1,000IU/L and declining

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27
Q

A 24-year-old woman attend with her partner having tried to conceive for 2 years. She has a regular 35 day cycle and her last menstrual period was 3 weeks ago. A recent STI screen was unremarkable. As part of the initial investigations for subfertility, she has progesterone checked to confirm ovulation.

On which day of her menstrual cycle should she have the blood test for progesterone?

Day 1-5
Day 14
Day 21
Day 28
Day 35

A

To confirm ovulation: Take the serum progesterone level 7 days prior to the expected next period
- This woman has a 35 day cycle so 35 - 7 days = day 28. Therefore day 28 is the day that a serum progesterone should be taken.

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28
Q

What are the three cardinal symptoms of endometriosis? [3]

A

Dysmenorrhoea (usually a few days before the onset of menstruation), dyspareunia and pelvic pain

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29
Q

A patient has Turner’s syndrome.

Which of the following will they most likely have?

Increased FSH/LH
Imperforate hymen
Increase in prolactin
Increased serum androgen levels
Increased oestrogen

A

Increased FSH/LH

For FSH & LH
* KALLman = FALL (Low FSH & LH)
* TURNer = TURNed up (High FSH & LH)

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30
Q

For FSH & LH - how can you remember which congenital syndromes cause which changes to them? [2]

A

For FSH & LH
* KALLman = FALL (Low FSH & LH)
* TURNer = TURNed up (High FSH & LH)

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31
Q

Patient with menopause.

Out of the following options, which is most likely to increase her risk of breast cancer?

Clonidine
Combined hormone replacement therapy (HRT)
Low dose progesterone
Oestrogen only HRT
Venlafaxine

A

Patient with menopause.

Out of the following options, which is most likely to increase her risk of breast cancer?

Combined hormone replacement therapy (HRT)
- HRT: adding a progestogen increases the risk of breast cancer
- O x P = increased risk of breast cancer

NB: increased risk of breast cancer: proBREASTerone <3

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32
Q

Why might fibroids have pedal oedema as a presenting feature? [1]

A

Venous congestion as fibroid presses on abdominal veins like IVC

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33
Q

What is a Nabothian cyst? [1]

Describe the colour of Nabothian cysts [1]

A

Nabothian cysts are cysts on the cervix that occur when the squamous-cell epithelium of the cervix slightly covers the columnar epithelium. As the columnar epithelium secretes mucous, the mucous becomes trapped, and cysts form

The cysts contain yellow/amber mucous and are usually located around the os where the epitheliums transition.

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34
Q

How do you exactly manage a miscarriage? [2] Include doses and timings

A

200 mg oral mifepristone and 48 hours later, 800 micrograms oral misoprostol

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35
Q

ruptured ectopic pregnancy - which is first line:
- Salpingotomy or Salpingectomy? [1]

A

Salpingectomy - the removal of the affected fallopian tube, is the preferred surgical treatment, especially in cases where the patient is haemodynamically unstable or there is a high risk of rupture.

NB: salpingotomy (removal of the ectopic pregnancy while preserving the fallopian tube) is an option in some cases, it is generally considered when the patient has only one functioning fallopian tube or fertility preservation is a priority

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36
Q

A diagnosis of premature ovarian insufficiency is suspected.
Which of the following is most likely to be found?

Low LH level

Low FSH level

Raised oestradiol level

Raised testosterone level

Raised FSH level

A

A diagnosis of premature ovarian insufficiency is suspected.
Which of the following is most likely to be found?

Raised FSH level:
- The history described above is most consistent with a diagnosis of premature ovarian insufficiency. It is characterised by the onset of menopausal symptoms before the age of 40 years with raised gonadotrophin levels including FSH and LH.
- A repeat sample should be taken 4-6 weeks apart to confirm the elevated FSH levels

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37
Q

Which of the following strains is most likely associated with anal cancer?

HPV 31

HPV 16

HPV 18

HPV 6

HPV 8

A

HPV 16

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38
Q

There are three criteria for use of lactational amenorrhoea as an effective contraceptive choice for women in the post partum period [3]

A

The woman has complete amenorrhoea.
The woman must be exclusively breast feeding day and night.
It has been six months or less since the birth of the baby

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39
Q

Which one of the following medications is an example of a muscarinic antagonist?

Tolterodine
Teriparatide
Toremifene
Finasteride
Tamsulosin

A
  1. Tolterodine = muscarinic receptor antagonist [urinary frequency, urinary urgency, urinary incontinence]
  2. Teriparatide = parathyroid hormone analogue [osteoporosis]
  3. Toremifene = selective oestrogen receptor modulator [hormone-dependent breast cancer] (same drug class as Tamoxifen)
  4. Finasteride = 5a-reductase inhibitor [benign prostatic hyperplasia]
  5. Tamsulosin = alpha adrenoceptor blocker [benign prostatic hyperplasia]
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40
Q

She is found to have stage 2 ovarian cancer. What is the primary treatment?

Chemotherapy
Radiotherapy
Surgical excision of the tumour
Hormone therapy
Biological therapy

A

Surgical excision of the tumour
- Ovarian cancers which are stage 2-4, are treated primarily by surgical excision of the tumour. This may be accompanied by chemotherapy. NICE CG122

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41
Q

What is the best way to detect ovulation? [1]

A

Day 21 progesterone test is the most reliable test to confirm ovulation
- In simple terms, measure serum progesterone 7 days prior to expected next period (for 28-day cycle: 28 - 7 = 21. For 35-day cycle: 35 - 7= 28)

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42
Q

In terms of her VTE risk, which of the following HRT options is safest? [1]

A

Transdermal HRT does not appear to increase the risk of VTE (vs. oral)

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43
Q

Name two risk factors that can cause an ovarian cyst to rupture [2]

A

Sex
Strenous exercise

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44
Q

[] is the most common cause of postmenopausal bleeding

A

Vaginal atrophy is the most common cause of postmenopausal bleeding

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45
Q

Treatment for mild, moderate and severe PMS? [3]

A

mild symptoms can be managed with lifestyle advice:
- apart from the usual advice on sleep, exercise, smoking and alcohol, specific advice includes regular, frequent (2-3 hourly), small, balanced meals rich in complex carbohydrates

moderate symptoms
- may benefit from a new-generation combined oral contraceptive pill (COCP)
- examples include Yasminµ (drospirenone 3 mg and ethinylestradiol 0.030 mg)

severe symptoms
- may benefit from a selective serotonin reuptake inhibitor (SSRI)
- this may be taken continuously or just during the luteal phase (for example days 15-28 of the menstrual cycle, depending on its length)

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46
Q

How do you treat a women with 1a cervical cancer if they want to maintain fertility? [1]
What would be if she didn’t care about fertility? [1]

A

Women with stage IA cervical cancer may be considered for a cone biopsy with negative margins if they wish to maintain their fertility
- Hysterectomy without lymph node clearance is an option to consider for IA1 tumours, but this would not preserve her fertility.

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47
Q

In which situations would you admit a patient with HG? [2]

A

Nausea and vomiting in pregnancy: admission should be considered in cases of ketonuria and/or weight loss despite use of oral anitemetics

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48
Q

Urinary incontinence - first-line treatment:
urge incontinence: []
stress incontinence: []

A

Urinary incontinence - first-line treatment:
urge incontinence: bladder retraining
stress incontinence: pelvic floor muscle training

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49
Q

Ovarian torsion may be associated with a [] sign on ultrasound imaging

A

Ovarian torsion may be associated with a whirlpool sign on ultrasound imaging

50
Q

How would you council a patient about need for contraception if they have a menopause? [2]

A

12 months after the last period in women > 50 years
24 months after the last period in women < 50 years

51
Q

[] is the gold-standard investigation for patients with suspected endometriosis

A

Laparoscopy is the gold-standard investigation for patients with suspected endometriosis

52
Q

A pregnancy test should be performed at [] weeks following medical management of a miscarriage

A

A pregnancy test should be performed at 3 weeks following medical management of a miscarriage

53
Q

What would be a contraindication for LNG-IUS being used as treatment for menorrhagia for fibroids? [1]

A

cannot be used if there is distortion of the uterine cavity

54
Q

How does LNG-IUS work to treat fibroids? [2]

A

Releases progesterone locally, thinning the uterine lining and reducing bleeding

55
Q

Name two side effects of using GnRH agonists for fibroid treatment? [2]

A

menopausal symptoms (hot flushes, vaginal dryness) and loss of bone mineral density

56
Q

Stereotypical PCOS results:
* [] LH:FSH ratio
* testosterone may be [] or []
* SHBG is []

A

Stereotypical PCOS results:
* raised LH:FSH ratio
* testosterone may be normal or mildly elevated
* SHBG is normal to low

57
Q

If a patient has a clotting disorder causing menorrhagia - which is it most likely to be? [1]

A

Von Willebrand’s disease is an inherited disorder of coagulation that leads to either a deficiency or a malfunction of von Willebrand factor. It is a recognised cause of menorrhagia (heavy periods). People affected may have a history of easy bruising, bleeding from minor wounds and in females menorrhagia from the onset of menarche such as in this patient. To confirm the diagnosis, blood can be sent for von Willebrand antigen testing and von Willebrand factor function assay. Typically patients with von Willebrand’s disease have prolonged activated partial prothrombin time (APTT) as seen in this patient, which is required to stabilise factor 8. Bleeding time is also prolonged because von Willebrand Factor is required for platelet function.

58
Q

Abdominal pain. Recent menstruation (2/7 ago)

TVUS given. A cyst is seen - what is the most likely type? [1]

A

Corpus luteal cyst:
- During ovulation, the dominant follicle ruptures to release an egg. This process may itself be accompanied by pain. The follicle then becomes the corpus luteum, which acts to secrete hormones in preparation of pregnancy. If pregnancy does not occur, the corpus luteum involutes and regresses. Failure of the corpus luteum to regress may result in a corpus luteal cyst, which can rupture and cause pain. These are considered physiological and almost always resolve spontaneously.
Provided there is no evidence of torsion, and pain is controlled, conservative management is usually first line

59
Q

The risks of developing breast and [] cancer are markedly increased in people who inherit a harmful change in BRCA1 or BRCA2.

A

19 Jul 2024 — The risks of developing breast and ovarian cancer are markedly increased in people who inherit a harmful change in BRCA1 or BRCA2.

60
Q

A patient presents with ?PID.

What is the most likely organism that has caused this? [1]

A

Chlaymdia trachomatis

61
Q

[] is the gold standard diagnostic tool for confirming ovarian torsion and facilitating immediate intervention.

A

Laparoscopy is the gold standard diagnostic tool for confirming ovarian torsion and facilitating immediate intervention.

62
Q

How do you distinguish between PMS and primary dysmenorrhia? [1]

A

PMS is before the luteal phase which is at least 10 days

symptoms 4-12 hours prior to menstruation and no mention of emotional symptoms makes primary dysmenorrhia more likely

E.g.: PMS The week before her period she has noticed a significant change in her mood. She feels incredibly low and anxious, with poor concentration.

63
Q

Name three typical risk factors that occur in questions that would indicate endometrial cancer? [3]

A

60-year-old obese, nulliparous woman presenting with vaginal bleeding

This malignancy is characteristic of women who are older than 60 years old, and obese patients are at particular risk, as increased levels of peripheral fat increase aromatase activity, which leads to the conversion of androgens to oestrogens, which directly promotes endometrial proliferation. Additionally, the fact that the bleeding is worse following sexual intercourse but the intercourse itself is not painful, points away from the other likely diagnosis of vaginal atrophy, making a diagnosis of endometrial cancer the most likely.

64
Q

How can you distinguish if PV bleeding is atrophic vaginitis vs endometrial cancer based off their history? [1]

A

If bleeding is worse following sexual intercourse but the intercourse itself is not painful, points away from the diagnosis of vaginal atrophy, making a diagnosis of endometrial cancer the most likely.

65
Q

How do you manage patients with symptoms of an ectopic based of their length of gestation [2]

A

< 6 weeks gestation:
- women have bleeding, but NO pain or risk factors for ectopic pregnancy, then they can be managed expectantly

>= 6 weeks gestation:
- and the woman has bleeding she should be referred to an early pregnancy assessment service for a transvaginal ultrasound scan to identify the location of the pregnancy and whether there is a fetal pole and heartbeat.

66
Q

Describe the dietary advice you would give for someone who suffering from PMS? [1]

A

Regular, frequent (2-3 hourly), small, balanced meals rich in complex carbohydrates

67
Q

[] is the most common identifiable cause of postcoital bleeding

A

Cervical ectropion is the most common identifiable cause of postcoital bleeding

68
Q

A patient presents with ?stress incontinence.

What do you have to investigate / rule out before making a stress incontinence dx? [2]

What tests would reveal stress incontinence after these prior tests have been performed?

A

urinalysis should be performed in order to exclude diabetes or a urinary tract infection before diagnosing stress incontinence

uroflometry to diagnose stress incontinence and cystmetrography to diagnose urge incontinence

69
Q

4 stages of ovarian cancer? [4]

A

Stage 1 Tumour confined to ovary
Stage 2 Tumour outside ovary but within pelvis
Stage 3 Tumour outside pelvic but within abdomen
Stage 4 Distant metastasis

NB:
Stage 1 (1 word) = ovary
Stage 2 (2 words) = ovary + pelvis
Stage 3 (3 words) = ovary + pelvis + abdomen

70
Q

Urge incontinence, often due to detrusor overactivity, may require [] treatment when first-line anticholinergics are contraindicated.

Why might they be contraindicated? [1]

A

Anticholinergics are contraindicated in myasthaenia gravis as they can precipitate a crisis OR if elderly

Instead - give botox

71
Q

Which is the most likely cell type if ovarian cancer is diagnosed?

Stromal-cell tumours

Ductal-cell carcinoma in situ (DCIS)

Germ-cell tumour

Epithelial-cell tumour

A

Which is the most likely cell type if ovarian cancer is diagnosed?

Epithelial-cell tumour
- The most likely diagnosis here is ovarian cancer. Around 90% of ovarian tumours are epithelial-cell tumours. Epithelial-cell tumours are thought to arise from the lining of the fimbriae in the fallopian tubes.
- Serous cystadenocarcinoma is the most common subtype of epithelial ovarian cancer and is characterised by the presence of Psammoma bodies on histology.

72
Q

BRCA1 gene mutation in the context of raised [] and pelvic mass is a risk factor for [] cancer.

A

BRCA1 gene mutation in the context of raised CA125 and pelvic mass is a risk factor for ovarian cancer.

73
Q

What is the most common type of uterine fibroid?

Extrauterine fibroid

Subserosal fibroid

Pedunculated subserosal fibroid

Intramural fibroid

Submucosal fibroid

A

What is the most common type of uterine fibroid?

Intramural fibroid
- Intramural fibroids are the most common form of fibroid and are located within the myometrium. If they enlarge, they can distort the uterus and can cause issues with intrauterine system insertion and future pregnancies.

74
Q

How do you manage / how does screening occur for high risk HPV but negative cytological smears? [2]

A

High risk HPV and negative cytology - repeat in a year

If same result again - refer for colposcopy

75
Q

Lynch syndrome refers to which group of cancers associated togther?

A

People affected by LS have a higher risk of developing:
* colon cancer
* rectal cancer
* endometrial cancer
* ovarian cancer

And they have a slightly higher risk of developing:
* stomach cancer
* pancreatic cancer
* small bowel cancer
* ureter and renal pelvis cancer.

76
Q

complex papillary architecture, nuclear atypia and the presence of Psammoma bodies’.
Which of the following is the best description of the patient’s ovarian lesion?

Serous cystadenocarcinoma

Mucinous cystadenocarcinoma

Dysgerminoma

Krukunberg tumour

Mature teratoma

A

Serous cystadenocarcinoma
- Epithelial ovarian cancer is the most common type of ovarian cancer comprising approximately 90% of all ovarian tumours. Serous cystadenocarcinoma is the most common subtype of epithelial ovarian cancer and is characterised by the presence of Psammoma bodies on histology.

77
Q

Psammoma bodies on histology indicate which type of ovarian cancer? [1]

A

Serous cystadenocarcinoma (the most common type of epithelial ovarian cancer)

78
Q

What is a key differential for PCOS? [1]

A

hypothyroidism

79
Q

A Bartholin’s cyst becomes infected.

What is the most likely causative organism? [1]

A

E. coli

80
Q

Premature Ovarian Insufficiency - how do you treat? (include age treated to) [1]
Why do you give this medication? [2]

A

HRT until 51
- prevent osteoporosis, as well as to protect against symptoms of oestrogen deficiency and possible cardiovascular complications

81
Q

How do you manage a women with repeat high-risk HPV but negative cytology? [1]

A

Women with repeat high-risk HPV but negative cytology require repeat cervical screening in 12 months.

82
Q

What’s a way of remembering first line treatment for surgical management of ectopic? [1]

A

Ectopic pregnancy requiring surgical management: salpingectomy is first-line (rather than salpingotomy) for women with no other risk factors for infertility
- salpingEctomy is before salpingOtomy in alphabet

83
Q

Describe the risks of HRT and which hormones specifically cause them [4]

A

Breast cancer has increased risk from combined HRT - specifically the progesterone component

Unopposed oestrogen causes in an increased risk of endometrial cancer (which is why it’s never given in women with a uterus)

Increased risk of VTE from systemic HRT - reduced by giving as transdermal patch due to progesterone

HRT for 10+ years after menopause increases the risk of stroke

84
Q

The whirl pool sign refers to an ovarian [cyst or torsion]?

A

The whirl pool sign in this case refers to an ovarian torsion - its caused by the blood vessels being twisted

Whirpool = spinning = torsion

85
Q

Which triad is used to dx HG? [3]

A
  • 5% pre-pregnancy weight loss
  • dehydration
  • electrolyte imbalance
86
Q

[] are first-line in the management of nausea & vomiting in pregnancy/hyperemesis gravidarum

A

Antihistamines are first-line in the management of nausea & vomiting in pregnancy/hyperemesis gravidarum

AntiHistamines for HG

87
Q

Risk malignancy index (RMI) prognosis in ovarian cancer is based on which three components? [3]

A

Risk malignancy index (RMI) prognosis in ovarian cancer is based on US findings, menopausal status and CA125 levels

88
Q

A patient presents with the following:
* mid-cycle ovulatory pain (4/10)
* pain can vary from being right-sided to left-sided
* Duration of pain can vary from minutes up to a few days

What is the most likely diagnosis? [1]
How can you manage this? [1]

A

Mittelschmerz is mid-cycle ovulatory pain and it is common.
* The pain is due to rupture of the Graafian (dominant) follicle, each month, which results in the release of an ovum into the fallopian tube.
* The pain can vary from being right-sided to left-sided depending on which ovary is ovulating that month.
* Duration of pain can vary from minutes up to a few days and it can be controlled using simple analgesics such as paracetamol and NSAIDs

89
Q

How do you treat CIN1 cytology? [1]

A

50-60% of CIN 1 will spontaneously regress within 2 year and the malignant potential is low, so conservative management with repeat cytology in 6 months is usually recommended if there are no other risk factors

90
Q

What is the most common cause of pruritus vulvae?

Lichen sclerosus
Psoriasis
Pubic lice
Contact dermatitis
Lichen simplex

A

What is the most common cause of pruritus vulvae?

Contact dermatitis
- This is either a delayed allergic reaction to allergens like medication, contraceptive creams/gel, latex, etc. or an irritant reaction to chemical or physical triggers like humidity, detergents, solvents or friction/scratching etc.

91
Q

How do you manage the risk of cervical cancer in patients with HIV? [1]

A

Annual cytology

92
Q

Which is the most important consideration when prescribing this medication to the patient?

Avoid use for more than 5 days due to risk of acute dystonia
Prolonged use leads to a small increased risk of the baby having a cleft lip
Prolonged use may lead to hyperprolactinaemia and associated complications
She will require additional IV vitamin supplementation
The drug can cause diarrhoea

A

Which is the most important consideration when prescribing this medication to the patient?

Avoid use for more than 5 days due to risk of acute dystonia
Prolonged use leads to a small increased risk of the baby having a cleft lip
Prolonged use may lead to hyperprolactinaemia and associated complications
She will require additional IV vitamin supplementation
The drug can cause diarrhoea

93
Q

Cervical cancer screening: if 2nd repeat smear at 24 months is still hrHPV +ve → [?]

A

Cervical cancer screening: if 2nd repeat smear at 24 months is still hrHPV +ve → colposcopy

94
Q

Which of the following ovarian tumours is associated with the development of endometrial hyperplasia?

Thecomas
Sertoli cell tumours
Fibromas
Teratomas
Granulosa cell tumours

A

Which of the following ovarian tumours is associated with the development of endometrial hyperplasia?

Granulosa cell tumours
- Atyplical hyperplasia of the endometrium is classified as a premalignant condition
- granulosa cells make oestrogen which causes endometrial hyperplasia

95
Q

Lynch syndrome causes which cancers? [3]

A

Lynch Syndrome is the CEO of cancers
* Colon
* Endometrial
* Ovarian

96
Q

Around 1 in 5 women who undergo a salpingotomy for an ectopic pregnancy require further treatment. What is this treatment? [1]

A

Around 1 in 5 women who undergo a salpingotomy for an ectopic pregnancy require further treatment: methotrexate and/or a salpingectomy

97
Q

What is the most appropriate investigation to diagnose premature ovarian failure?

Progesterone level
Ovarian ultrasound
Follicle stimulating hormone level
Serial measurement of basal body temperature
Oestrogen level

A

Follicle stimulating hormone level

98
Q

A 50-year-old lady is commenced on tamoxifen for the treatment of an oestrogen receptor positive breast cancer. Which of the following malignancies are associated with tamoxifen use?

Adenocarcinoma of the colon
Hodgkins lymphoma
Adenocarcinoma of the lung
Ovarian cancer
Endometrial cancer

A

Endometrial cancer

99
Q

How should you counsel this woman on the risks of ondansetron use in pregnancy?

There are no recognised risks for her, the pregnancy or the newborns
There is a small but significant risk of spontaneous miscarriage in twin pregnancies
There is a small increased risk of cleft lip/palate in the newborn if used in the first trimester
There is an established risk of severe congenital heart defects in the newborn and it should be stopped
There is some evidence of an increased rate of developing HELLP syndrome in the 3rd trimester

A

There is a small increased risk of cleft lip/palate in the newborn if used in the first trimester

Ondansetron - Orofacial malformation - Trimester One

100
Q

Polycystic ovarian syndrome (PCOS) increases the long-term risk of which of the following conditions?

Cervical cancer
Osteoporosis
Endometrial cancer
Endometriosis
Vulval intra-epithelial neoplasia

A

Polycystic ovarian syndrome (PCOS) increases the long-term risk of which of the following conditions?

Endometrial cancer
- The polycystic ovaries develop and secrete oestrogen (like any developing follicle), but as there’s no corpus luteum (because the follicles don’t fully mature, and rupture), theres no progesterone to protect against the high oestrogen

101
Q

What is functional incontinence? [1]
What is overflow incontinence? [1]

A

functional incontinence - physical disability prevent from urinate (eg.wheelchair/bedridden)

overflow incontinence - poor stream/incomplete emptying

102
Q

How do you differentiate between androgen insensitivity syndrome and congenital adrenal hyperplasia? [3]

A

Androgen insensitivity syndrome (AIS)
- This patient has presented with primary amenorrhoea as she has failed to establish menstruation by 15 years of age.
- The blood tests show increased testosterone and her examination shows little to no axillary or pubic hair and bilateral lower pelvic masses.
- These findings all point in the direction of AIS, which is an X-linked recessive condition characterised by end-organ resistance to testosterone, causing genetically male children (46XY) to have a female phenotype.
- The bilateral lower pelvic swellings are likely to be undescended testes and testosterone is elevated due to tissues being unresponsive to it.

Congenital adrenal hyperplasia (CAH)
- Although this can also cause primary amenorrhoea, this is associated with the development of male secondary sexual characteristics in females (such as deep voice and hirsutism)
- This is because of impaired cortisol synthesis leading to surplus progesterone which is converted to extra testosterone to reduce the levels of progesterone.
- Unlike AIS, the body is still responsive to testosterone, therefore, this would mean that this patient would have hirsutism and excess male-pattern hair growth, including axillary and pubic hair.

103
Q

What is a mneuomnic for the causes of endometrial hyperplasia? [7]

A

Endometrial hyperplasia

MOONTA Street

Menarchy extremes
Obesity
Oestrogen
Nulliparity
Tamoxifen
Age35+
Smoking

104
Q

What effect does Turner’s syndrome have on FSH/LG? [1]

A

Raised FSH/LH in primary amenorrhoea - consider gonadal dysgenesis (e.g. Turner’s syndrome)

105
Q

Which diseases is ergometrine CI in? [3]

A

Ergometrine can cause uncontrolled hypertension due to its smooth muscle constriction and cerebral vasospasm properties. It is also contraindicated in people with peripheral vascular disease or heart disease.

106
Q

How do you treat molar pregnancies? [1]

A

surgically using a dilatation and curettage

107
Q

How do you follow up treatment for molar pregnancies? [2]
How do you particularly manage for partial [1] and complete moles? [1]

A

Bimonthly serum and urine hCG testing until levels are normal.
* In the case of a partial mole, a repeat hCG test is done 4 weeks later - if normal, the patient is discharged from surveillance.
* In a complete mole, monthly repeat hCG samples are sent for at least 6 months.

108
Q

How do you calculate estimation date for pregnancy? [1]

A

The calculation is to add one year and seven days to the first day of the LMP and subtract three months.

109
Q
A
110
Q

What are the answers for the following:

  1. Commonst type of ovarian cyst due to non rupture of follicle?
  2. Can present with intraperitoneal bleed?
  3. Most common benign ovarian tumour in women under 30 that is associated with ovarian torsion?
  4. Ectopic tissue in ovary aka chocolate cyst
  5. Become massive and cause pseudomyxoma peritonei
  6. Resembles most common ovarian cancer
A
  1. Commonst type of ovarian cyst due to non rupture of follicle? follicular cysts
  2. Can present with intraperitoneal bleed? corpus luteum cyst
  3. Most common benign ovarian tumour in women under 30 that is associated with ovarian torsion? dermoid cyst
  4. Ectopic tissue in ovary aka chocolate cyst endometrioma
  5. Become massive and cause pseudomyxoma peritonei mucinous cystadenoma
  6. Resembles most common ovarian cancer: serous cystadenoma
111
Q

What is an easy way of remebering which type of ovarian cysts cause a pseudomyxoma and which is most common? [2]

A

pseudoMyxoma - Mucinous
SErous - Seriously common Epithelial

112
Q

How would you be able to distinguish an ectopic from a miscarriage (apart from imaging and looking at cervix opening)? [1]

A

In the case of pregnancy of unknown location, serum bHCG levels >1,500 points toward a diagnosis of an ectopic pregnancy

113
Q

Why you not give patients with HG dextrose? [1]

A

As thiamine deficiency is common in patients with hyperemesis gravidarum; fluids containing dextrose should not be given as dextrose increases the body’s need for thiamine which might precipitate Wernicke encephalopathy.

114
Q

On examination, the gynaecologist notes an enlarged, boggy uterus.

What does this indicate? [1]

A

adenomyosis

115
Q

[] should be suspected in patients with continuous dribbling incontinence after prolonged labour and from an area with limited obstetric services.

A

Vesicovaginal fistulae should be suspected in patients with continuous dribbling incontinence after prolonged labour and from an area with limited obstetric services.

116
Q

Which nerve is the most likely to be damaged during childbirth?

Obturator
Femoral
Sciatic
Lumbrosacral

A

Which nerve is the most likely to be damaged during childbirth?

Obturator
Femoral
Sciatic
Lumbrosacral

117
Q

Which of the following is most likely to occur because of damage by forceps during childbirth?

  • Weakness in knee extension, loss of the patella reflex, numbness of the thigh
  • Weakness in ankle dorsiflexion, numbness of the calf and foot
  • Weakness in knee flexion and foot movements, pain and numbness from gluteal region to ankle
  • Weakness in hip adduction, numbness over the medial thigh
A
  • Weakness in hip adduction, numbness over the medial thigh due to obturator nerve damage
118
Q

A patient presents with severe PMS.

Describe how often you / when you prescribe the SSRIs [1]

A

SSRIs, either continuously or during the luteal phase, may help premenstrual syndrome

119
Q

HRT: adding a progestogen increases the risk of [] cancer

A

HRT: adding a progestogen increases the risk of breast cancer

120
Q

[] may develop during pregnancy, presenting with low-grade fever, pain and vomiting.

PMH of heavy periods

A

Fibroid degeneration may develop during pregnancy, presenting with low-grade fever, pain and vomiting.

Year 4: OB-GYN (40 decks)

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