1
Q
what is Sheehan’s syndrome
A
ischaemic necrosis of the pituitary gland in the post partum period often due to blood loss and hypovolaemic shock.
2
Q
signs of Sheehans syndrome
A
Features of hypopituitarism:
- hypothyroidism (fatigue, cold intolerance, constipation, weight gain, hair loss),
- hypoadrenalism (fatigue, weight loss, hypoglycemia, hyponatremia, confusion),
- hypogonadism (amenorrhea, hot flashes, loss of libido , can’t breastfeed)
- growth hormone deficiency (fatigue and reduced muscle mass).
3
Q
Diagnostic investigation for ovarian torsion
First line investigation
A
- diagnostic laparoscopy - allows for treatment straight away.
- Transvaginal USS used 1st line - shows whirlpool sign, oedema of ovary or free fluid in pelvis
4
Q
signs of ovarian torsion on USS
A
- Whirlpool sign
- Free fluid in pelvis
- Oedema of ovary.
5
Q
what symptom is associated with pain in ovarian torsion
A
N+V
6
Q
what drugs are used in termination of pregnancy + how do they work
A
- mifepristone: anti-progestogen that stops progression of the pregnancy.
- misoprostol: PG analogue that stimulates uterine contractions to expel the foetus.
7
Q
typical presentation of vulval cancer.
A
- A lump that may be associated with groin lymphadenopathy
- Vulval skin changes – thickening or colour change
- Non-healing ulcer
- Itching or discomfort in vulval area
- Bleeding or discharge not related to menstrual cycle
- MC affects the labia majora with irregular mass, fungating lesion, ulceration or bleeding.
8
Q
PMS Mx
A
- conservative: exercise, CBT, diet modification, Vitamin B
- Meds: COCP is useful for women with PMS however some suffer progestogenic side effects during the pill-free period. Therefore choosing a regime that has a shorter break, or no pill-free period may be more effective
9
Q
ovarian cancer Ix and when each is done
A
- Ca-125 done in older women with new abdominal Sx
- TV+TA USS: done when Ca-125 >35
- further imaging includes CT chest abdomen pelvis
10
Q
The most commonly used medication for infertility in women with PCOS is…
A
clomifene
11
Q
medical Mx for PCOS in women not bothered about fertility
A
- co-cyprindiol - Reduces hirsutism and promotes regular menstruation.
- COCP - regulates period
- metformin - helps reduce acne + hirsutism and regulates period
12
Q
medical Mx for women with PCOS trying to conceive
A
- clomifene
- metformin
- Gonadotrophins: Utilised to induce ovulation if clomiphene and metformin prove ineffective
13
Q
HRT regimens and who gets what
A
HRT can be given continuously (for postmenopausal women not having periods) or cyclically (for perimenopausal women still having some periods).
14
Q
T/F
PID causes menorrhagia
A
true
15
Q
compressive Sx seen with fibroids
A
- urinary frequency
- constipation
- pedal oedema due to compression of the veins.
16
Q
- what is fibroid red degeneration
- when does it happen
- how does it present
- how is it managed
A
- Ischaemia, infarction + necrosis of the fibroid due to disrupted blood supply.
- Happens in larger fibroid >5cm, during 2nd or 3rd trimester as the fibroids grows fast and outgrows it’s supply or kinking of blood supply.
- Presents with severe abdo pian, low-grade fever, tachycardia ±vomiting.
- Management is supportive, with rest, fluids and analgesia
17
Q
red velvet halo around the cervical os is…
A
a cervical ectropion
- Often asymptomatic. May present with post-coital bleeding or vaginal discharge
- may require further Ix with colposcopy to rule out cervical cancer if suspicious
18
Q
HRT contraindications
A
- Undiagnosed vaginal bleeding
- Pregnancy
- Breastfeeding
- Oestrogen receptor-positive breast cancer
- Acute liver disease
- Uncontrolled hypertension
- History of breast cancer or venous thromboembolism (VTE)
- Recent stroke, myocardial infarction or angina
19
Q
overactive bladder syndrome Vs urge incontinence - Sx
A
- Overactive bladder causes a person to urinate more frequently and to feel a sudden and intense need to urinate.
- Urge incontinence on the other hand occurs when this urge to urinate causes urine to leak involuntarily
20
Q
cause of overactive bladder syndrome
A
overactivity of the detrusor muscle, the smooth muscle of the bladder, which contracts to allow urinary flow through the urethral sphincter.
21
Q
cause of urge incontinence
A
overactivity of the detrusor muscle, the smooth muscle of the bladder, which contracts to allow urinary flow through the urethral sphincter
22
Q
cause of stress incontinence
A
weak pelvic floor muscles + weakness of the sphincter muscles
23
Q
criteria for PCOS Dx
A
Rotterdam criteria
- hyperandrogegism: acne or hirsutism
- polycystic ovaries - string of pearls
- ovulatory dysfunction - oligo/an-ovulation
24
Q
criteria for BV
A
Amsel criteria
- clue cells on microscopy
- thin white/grey discharge
- +ve whiff test
- pH >4.5
25
In women under 40 with unexplained amenorrhoea and menopausal symptoms, raised Follicle-stimulating hormone (FSH) levels suggests...
premature ovarian insufficiency.
26
define premature ovarian insufficiency
a medical condition characterised by the onset of menopause (ovarian insufficiency) in a woman aged below **40 years**
27
how is premature ovarian insufficiency diagnosed
FSH levels: two samples taken 4-6 weeks apart, showing raised FSH levels is required for diagnosis
28
Mx for premature ovarian insufficiency
The primary management strategy for women with POI is to offer hormone replacement therapy (HRT) until at least the expected age of menopause, unless the risks of HRT treatment outweigh the benefits. options are:
- traditional HRT
- COCP
29
30
signs of hypokalaemia on ECG
U waves,
small or absent T waves,
prolonged QT and PR intervals along with
ST depression.
31
what HRT regimen should you give perimenopausal women
Monthly cyclical hormone-replacement therapy where oestrogen is taken daily, and a progestogen is given for 10–14 days of each cycle as this mimics premenopausal menstrual cycle with a withdrawal bleed
32
what HRT regimen should you give postmenopausal women
Continuous combined HRT is a treatment regimen whereby oestrogen and progestogen are both taken daily
33
1st line Mx of menorrhagia
mirena coil
if wanting to get pregnant - TXA
34
what is a nabothian cyst
Nabothian cysts are normal cervical findings in women [especially women that have had kids], appearing as small, amber mucous-filled cysts around the cervical os, resulting from epithelial transition areas that secrete and trap mucous.
35
lichen sclerosis 1st Line Tx
clobetasol 0.05% - potent topical steroid
36
protective factors for ovarian cancer
- breastfeeding as it temporarily inhibits ovulation
- pregnancies - same reason
37
when should an IUD be removed in PID
after 72 hours if no improvement with Abx tx.
38
1st, 2nd and 3rd line Mx for stress incontinence
1. Lifestyle changes [fluid intake and caffeine intake] + pelvic floor exercises for 3 months
2. surgery - retro-pubic mid-urethral tape.
3. duloxetine - only used when pt is not fit for surgery or declines
39
what can cause Ca-125 to rise, other than ovarian cancer
1. Menstruation,
1. endometriosis,
1. benign ovarian cysts,
1. pregnancy,
1. liver disease/ ascites
1. PID
1. adenomyosis
40
what Tx is given prior to fibroid surgery
GnRH agonists are used before surgery to reduce the size of fibroids and make them less likely to bleed during surgery. They induce a menopause-like state which reduces the amount of oestrogen maintaining the fibroid.
41
fibroid Mx
<3cm = same Mx as heavy menstrual bleeding
* 1st line = Mirena coil for small fibroids that don’t distort the uterus
* Symptomatic Mx with NSAIDs + Tranexamic acid.
* COCP or POP
* Surgical options: endometrial ablation, resection of submucosal fibroids, hysterectomy.
>3cm = referral to gynaecology
* Symptomatic management with NSAIDs and tranexamic acid
* Mirena coil – depending on the size and shape of the fibroids and uterus
* COCP or POP
* Surgical options: uterine artery embolization, myomectomy, hysterectomy.
* GnRH agonists, such as goserelin [Zoladex] or leuprorelin [Prostap], may be used to reduce the size of fibroids before surgery
42
duration and character of pelvic pain for endometriosis Dx
For the pain to be chronic in nature, it must be cyclical or continuous for over six months
43
when should a COCP be avoided
* Uncontrolled hypertension (particularly ≥160 / ≥100)
* Migraine with aura (risk of stroke)
* History of VTE
* Aged over 35 and smoking more than 15 cigarettes per day
* Major surgery with prolonged immobility
* Vascular disease or stroke
* Ischaemic heart disease, cardiomyopathy or atrial fibrillation
* Liver cirrhosis and liver tumours
* Systemic lupus erythematosus (SLE) and antiphospholipid syndrome
44
RFs for ectopic pregnancy
* Pelvic inflammatory disease
* Prior ectopic pregnancies
* IVF
* In situ intrauterine device.
* Endometriosis – scarring + adhesion
* Smoking
* POP
* Genital infection e.g. gonorrhoea
* Older maternal age >35
* Sexual activity <18
45
list some causes of superficial dyspaneuria
- lichen sclerosis
- thrush
- Genital herpes
- vaginismus
46
MC type of cyst
follicular - functional cyst
- These occur during the menstrual cycle when a follicle does not release an egg in ovulation.
- They are usually harmless and will self-resolve.
47
what cancers are associated with HPV 16+ 18
- cervical
- anal
48
vulval carcinoma Sx
Vulval carcinoma typically presents with vulval soreness, burning, pruritis and bleeding
49
atrophic vaginitis Sx
- thinning and dryness of the vulval skin and vaginal epithelium.
- It typically presents with vulval irritation, soreness and superficial dyspareunia. - Some women also report vaginal discharge changes
50
when would you refer a pt to specialist services for infertility
Regular unprotected intercourse for 1 year, without a successful pregnancy
OR
6 months of regular UPSI in women >35 as they have depleted egg stores
51
what is androgen insensitivity syndrome
- Androgen-insensitivity syndrome occurs when an individual has XY chromosomes (male sex), but their body does not respond to the androgen hormones that drive the development of the male body.
- Hence, they have externally female characteristics but no female reproductive organs
52
pelvic organ prolapse mx 1,2 + 3rd line
Conservative Mx: for pts with mild sx they can cope with or who can’t tolerate pessary
- Lifestyle changes: quit smoking, lose weight, avoid heavy lifting
- Physio = pelvic floor exercises
- Vaginal oestrogen cream
Vaginal pessary
- Help provide extra support to the pelvic organs, providing symptomatic relief.
- Removed + changed ~ every 4 months.
- Given with oestrogen cream to prevent vaginal wall irritation.
Surgical Mx:
-Definitive management
- May involve repair of native tissue or hysterectomy. NICE advise to avoid using mesh.
53
What serum marker is most specific for breast cancer monitoring?
ca15-3
54
Quesmed phase 3a
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