Reproductive and Sexual Health

Question 1

Investigation to confirm menopause

Answer 1

LH and FSH

2 seperate occasions

Question 2

Management Principles for menopause

Answer 2

Stress management
HRT
Manage menorrhagia

Question 3

Delivery of HRT: cyclical progesterone

Answer 3

Oestrogen always
Progesterone last 14 days of cycle
IF still menstruating

Question 4

Presentation of menopause (4)

Answer 4

Hot flushes
Oligomenorrhoea/Menorrhagia
Insomnia
Mood swings

Question 5

What is adenomyosis

Answer 5

Endometrium in the myometrium

Question 6

Presentation of adenomyosis (2)

Answer 6

Dysmenorrhoea

Menorrhagia

Question 7

Causes of endometritis (4)

Answer 7

Neisseria
Chlamydia
TB
IUD

Question 8

Association of chronic endometritis

Answer 8

PID

Question 9

Presentation of endometritis

Answer 9

Abnormal bleeding

Question 10

Management of endometritis/PID (2)

Answer 10

Analgesia - NSAIDs
Empirical antibiotics
- If IUD associated removal of IUD is encouraged

Question 11

What is the growth stimulus for fibroids?

Answer 11

Oestrogen-dependent benign tumour

Question 12

What is a polyp?

Association?

Answer 12

Endometrial overgrowth

Menopause

Question 13

Presentation of polyp

Answer 13

Abnormal bleeding

Abnormal discharge

Question 14

Types of epithelial ovarian tumours

Answer 14

Serous
Mucinous
Endometriod
Clear Cell

Question 15

What is seen in serous ovarian tumours

Answer 15

Psammoma bodies

Question 16

What is the origin of most cases of serous ovarian tumour?

Answer 16

Tubal

Question 17

Association of mucinous ovarian tumour

Answer 17

Pseudomyxoma peritoni

Question 18

Associations of endometriod and clear cell ovarian tumour

Answer 18

Endometriosis

Lynch Syndrome

Question 19

Risk factors for ovarian tumour

Answer 19

Nulliparity

Increasing age

Question 20

Types of sex cord and stromal tumours

Answer 20

Fibroma
Theca cell (sertoli and leydig cell tumours)
Granulosa cell

Question 21

Types of germ cell tumour

Answer 21

Yolk sac
Teratoma
Choriocarcinoma
Dysgerminoma

Question 22

Presentation of theca cell tumour

Answer 22

Increased production of androgens

= hirsutism

Question 23

What is seen in granulosa cell tumours

Answer 23

Call-exner bodies

Question 24

Hormonal feature of granulosa cell tumours

Answer 24

Production of oestrogen

Question 25

Associations of fibroma

Answer 25

Meig's syndrome

Question 26

Requirement for something to be a teratoma

Answer 26

Must contain all three embryological layers

Question 27

Ix findings in teratoma

Answer 27

May see calcifications on KUB

Question 28

What is seen in yolk sac tumour

Answer 28

Schiller-duval bodies

Question 29

Similar to dysgerminoma =

Answer 29

Testicular seminoma

Question 30

Androgen Insensitivity Syndrome Genotype and phenotype Genetics

Answer 30

46XY but external genitalia NOT male | X-linked recessive disorder

Question 31

Pathophysiology of androgen insensitivity

Answer 31

Mullerian inhibition doesnt occur = female | Androgen induction of wolffian ducts doesnt occur = not male

Question 32

Presentation of androgen insensitivity

Answer 32

Primary amenorrhoea Short vagina Lack of pubic hair

Question 33

Causes of obstructive male infertility (3)

Answer 33

CF Vasectomy Infection

Question 34

Investigation in obstructive male infertility

Answer 34

Normal | LH, FSH, testosterone

Question 35

Presentation of obstructive male infertility

Answer 35

Normal 2y sexual characteristics | Absence of vas deferens

Question 36

Causes of non-obstructive male infertility (6)

Answer 36

``` Mumps Iatrogenic Klinefelters Kallmans Anorexia Tumours ```

Question 37

Presentation of non-obstructive male infertility

Answer 37

Reduced 2y sexual characteristics Vas deferens present Low testicular volume

Question 38

Ix of non-obstructive male infertility

Answer 38

High LH and FSH Low testosterone (In Kallmans = hypogonadotrophic hypogonadism - low LH and FSH)

Question 39

Risk factor for SSC of cervix

Answer 39

HPV (types 16 and 18)

Question 40

Risk factors for adenocarcinoma of cervix

Answer 40

Associated with higher SE | Smoking

Question 41

Presentation of SSC of cervix

Answer 41

Post-coital bleeding

Question 42

Staging of SSC of cervix

Answer 42

S1 - confined to the cervix S2 - local spread S3 - pelvic and lymphatic spread S4 - distant spread

Question 43

Pathology of adenocarcinoma of cervix

Answer 43

Proliferation of glandular epithelium

Question 44

Where does CIN occur

Answer 44

Transformation zone of the cervix

Question 45

Associations with CIN

Answer 45

Usually as a result of HPV infection | Can lead to invasive SSC

Question 46

Presentation of chlamydia (4)

Answer 46

Discharge Post-coital bleeding Cervicitis PID

Question 47

Management of syphillis

Answer 47

IM Benzylpenicillin

Question 48

Investigation pathway for syphillis

Answer 48

Dark brown microscopy 1. Combined IgM and IgG +VE - do IgM ELISA -VE - no further testing

Question 49

Presentation of syphillis | Early and later

Answer 49

Chancre | Papular rash

Question 50

Types of chlamydia that commonly cause infection

Answer 50

Serotypes D-K

Question 51

Investigation of chlamydia

Answer 51

First pass urine or high vaginal swab | Combined NAATs

Question 52

Pathophysiology of thromboembolic disease and pregnancy

Answer 52

Pregnancy is pro-thrombotic | Production of a large amount of clotting factors

Question 53

Management options of thromboembolic disease in pregnancy

Answer 53

Warfarin | Heparin

Question 54

Warfarin and pregnancy

Answer 54

Avoid weeks 6-12 Stop 6 weeks before the birth Safe for breast feeding

Question 55

Heparin and pregnancy

Answer 55

Can be given as prophylaxis | Stop 24 hours before birth

Question 56

High risk of thromboembolic events prophylaxis

Answer 56

Give heparin for 6 weeks post-natally

Question 57

TOP limit | Scottish limit for procecdure

Answer 57

23 + 6 weeks | Only go up to 18 + 6 in scotland

Question 58

HSA1

Answer 58

Used for TOP Requires 2 doctors to be in agreement Usually done under section C

Question 59

HSA2

Answer 59

Used for TOP | Emergency situation - cannot object

Question 60

Limits for types of TOP

Answer 60

Medical - 18+6 | Surgical 12

Question 61

Classification of medical TOP

Answer 61

Early - up to 9 weeks | Late - 9-12 weeks

Question 62

Type of surgical TOP

Answer 62

Vacuum - 6-12 weeks Manual vacuum - up to 9 weeks Surgical evacuation - 13-24 weeks NOT in Scotland

Question 63

Medical termination regime

Answer 63

Oral mifepristone 200mg | 24-48 hours later vaginal or oral prostaglandin

Question 64

Prophylaxis given in termination

Answer 64

Metronidazole

Question 65

Types of Monozygous twins

Answer 65

MCDA MCMA Conjoined

Question 66

Types of dizygous twins

Answer 66

DCDA

Question 67

What type of twin pregnancy is the highest risk?

Answer 67

Monozygous

Question 68

Split of DCDA twins

Answer 68

Day 1-3

Question 69

Split of MCDA

Answer 69

Day 4-8

Question 70

Split of MCMA

Answer 70

Day 8-13

Question 71

Conjoined twins split

Answer 71

Day 15+

Question 72

Presentation of twin pregnancy

Answer 72

Exaggerated symptoms Large for dates Multiple foetal poles

Question 73

Delivery for DCDA twins

Answer 73

37-38 weeks

Question 74

Delivery for MCDA

Answer 74

36 weeks