Download Gynecology Exam Questions With Verified Answers| Latest Update and more Exams Gynecology in PDF only on Docsity!
Gynecology Exam Questions With
Verified Answers| Latest Update
What cancer does polycystic ovarian syndrome (PCOS) increase the long term risk of? - Answer -endometrial cancer What conditions complicate PCOS? - Answer --chronic an ovulation -hyperandrogenism What are the long term complications of PCOS? - Answer --Subfertility -diabetes mellitus -stroke and TIA -Coronary artery disease -obstructive sleep apnoea -endometrial cancer these complications are further increased in patients who are obese What is the reason for increased endometrial hyperplasia and carcinoma in women with PCOS - Answer -it is due to
oligo/amenorrhea in the presence of pre-menopausal levels of oestrogen this risk is greatest in women with menstrual cycle lengths of >3months How can the risk of endometrial cancer be reduced in women with PCOS? - Answer -by inducing a withdrawal bleed every 1-3 months (using a combined contraceptive pill or cyclical medroxyprogestrone or with insertion of a Mirena coil Optimising BMI in overweight patients will help to regulate menstrual cycles thereby reducing the risk of endometrial hyperplasia Is there increased risk of osteoporosis in PCOS? - Answer -No because there is no oestrogen deficiency What is PCOS? - Answer -It is a complex condition of ovarian dysfunction thought to affect 5-20% of women of reproductive age the aetiology is not fully understood both hyperinsulinaemia and high levels of LH are seen in PCOS and there appears to be some overlap with the metabolic syndrome What are the features of PCOS - Answer --subfertility and infertility
e. ectopic pregnancy - Answer -complete miscarriage What is a complete miscarriage - Answer -it is a spontaneous abortion with expulsion of the entire foetus through the cervix pain and uterine contractions stop after foetus has been expelled diagnosis: ultrasound shows empty uterus What are the different types of miscarriages - Answer -- threatened miscarriage -missed (delayed) miscarriage -inevitable miscarriage -incomplete miscarriage -complete miscarriage What is a threatened miscarriage - Answer -painless vaginal bleeding occurring before 24 weeks but typically occurs at 6-9 weeks the bleeding is often less than menstruation cervical os is closed complicates up to 25% of all pregnancies
What is a missed (delayed) miscarriage? - Answer -a gestational sac which contains a dead foetus before 20 weeks without the symptoms of expulsion mother may have light vaginal bleeding/discharfge and the symptoms of pregnancy which disappear pain is not usually a feature cervical os is closed when the gestational sac is >25mm and no embryonic/fetal part can be seen is sometimes described as a 'blighted ovum' or 'anembryonic pregnancy' What is an inevitable miscarriage - Answer -heavy bleeding with clots and pain cervical os is open What is an incomplete miscarriage - Answer -not all products of conception have been expelled pain and vaginal bleeding cervical os is open What is the management of cervical cancer - Answer - simple hysterectomy is the preferred treatment choice for early stage disease in postmenopausal women
-smoking -HIV -early first intercourse, many sexual partners -high parity -lower socioeconomic status -combined oral contraceptive pill What is the mechanism for HPV causing cervical cancer?
- Answer -HPV 16 and 18 produces the oncogenes E and E7 genes respectively E6 inhibits the p53 tumour suppressor gene E7 inhibits RB suppressor gene A 37-year-old female presents to her GP complaining of dyspareunia, irregular menstrual cycles for 6 months until she recently missed 3 periods. She also complains of sudden hot flushes for the past 3 months. Her only history of note includes previous breast cancer for which she was on chemotherapy and radiation. Examination reveals no abnormalities and her pregnancy test is negative. What is the most likely diagnosis? - Answer -premature ovarian failure
Premature ovarian failure (POM) is defined as the cessation of menses for 1 year before the age of 40. It can, however, be preceded by irregular menstrual cycles. Common symptoms include hot flushes, vaginal dryness, vaginal atrophy, sleep disturbance, and irritability. What are the risk factors for premature ovarian failure - Answer -Strong risk factors for POM include a positive family history, exposure to chemotherapy/radiation and autoimmune disease. What is premature ovarian failure - Answer -it is defined as the onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years it occurs in around 1 in 100 women What are the causes of premature ovarian failure - Answer --idiopathic - the most common -chemotherapy -autoimmune -radiation
performed, and whether the uterine cavity was entered, the lady would need counselling in regards to delivery, since often a caesarean section is advised due to risk of uterine rupture. GnRH agonists effectively turn off the ovaries, which causes the fibroids to shrink and therefore are easier to remove surgically. On stopping the medication, the fibroids grow back. As this treatment turns off the ovaries, it inhibits ovulation and therefore means that pregnancy is not possible during this time. As a treatment on its own, it would not be suitable in this case as it causes temporary infertility and fibroid regrowth on cessation. However, if combined with a myomectomy, it would provide a suitable treatment option. Endometrial ablation destroys the endometrial lining, therefore meaning that an embryo would not be able to implant. Uterine artery embolisation is not recommended if trying to conceive as it cuts down the blood supply to the uterus significantly, therefore meaning that the fetus would be unable to implant and grow. Ulipristal acetate is a selective progesterone receptor modulator. It is used pre-operatively for women with fibroids as it has been proven to shrink them, thus making surgery easier. This medication affects fertility, thus is not suitable for women trying to get pregnant, unless (like GnRH agonists) it is used for a short period in combination with surgery.
What are uterine fibroids - Answer -they are benign smooth muscle tumours of the uterus they are thought to occur in around 20% of white and around 50% of black women in the later reproductive year What are the associations with uterine fibroids - Answer -- more common in Afro-Carribean women -rare before puberty, develop in response to oestrogen, don't tend to progress following menopause What are the features of uterine fibroids - Answer --may be asymptomatic -menorrhagia -lower abdominal pain: cramping pains, often during menstruation -bloating -urinary symptoms e.g frequency, may occur with larger fibroids -subfertility How is the diagnosis of fibroids made - Answer - transvaginal ultrasound
Women who are virgins may choose not to have cervical screening as their risk of cervical cancer is low - Answer - true What should happen to women with cervical stenosis - Answer -they should be referred to the colposcopy clinic for consideration of cervical dilatation Women with a cervix that cannot be visualised should be referred for colposcopy - Answer -true transgender men who have retained their cervix should be included in the national cervical screening programme unless they have made an informed decision to opt out - Answer -true unscheduled cervical screening is not recommended unless the woman is immunosuppressed, where more frequent screening may be required - Answer -true Which cervical cancers are not detected by screening - Answer -it should be noted that cervical adenocarcinomas which account for around 15% of cases are frequently undetected by screening Who is screened for cervical cancer and how often - Answer -A smear test is offered to all women between the ages of 25-64 years 25-49 years: 3-yearly screening
50-64 years: 5-yearly screening How is smear performed - Answer -There is currently a move away from traditional Papanicolaou (Pap) smears to liquid-based cytology (LBC). Rather than smearing the sample onto a slide the sample is either rinsed into the preservative fluid or the brush head is simply removed into the sample bottle containing the preservative fluid. Advantages of LBC includes -reduced rate of inadequate smears -increased sensitivity and specificity When is the best time to take a cervical smear - Answer -It is said that the best time to take a cervical smear is around mid-cycle. Whilst there is limited evidence to support this it is still the current advice given out by the NHS. A 24-year-old lady who is 8 weeks pregnant came in to the GP complaining of slight vaginal bleed and lower abdominal pain. The GP sent her for an assessment in the early pregnancy assessment unit and a transvaginal ultrasound scan was done. An ectopic pregnancy was then diagnosed. Which of the following is the most likely location of the ectopic pregnancy? - Answer -ampulla of fallopian tube What are the various sites of ectopic pregnancy and their prevalence - Answer -tubal ectopics: 93-97%
-endometriosis -IUCD -progesterone only pill -IVF (3% of pregnancies are ectopic) A 25-year-old woman is investigated for acute pelvic pain and is diagnosed as having pelvic inflammatory disease. What is the most common cause of pelvic inflammatory disease in the UK? - Answer -chlamydia trachomatis What is pelvic inflammatory disease - Answer -it is a term used to describe infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries and surrounding peritoneum it is usually the result of ascending infection from the endocervix What are the causative organisms in pelvic inflammatory disease - Answer --chlamydia trachomatis- the most common cause -Neisseria gonorrhoea -mycoplasma genitalium -mycoplasma hominis
What are the features of pelvic inflammatory disease - Answer --lower abdominal pain -fever -deep dyspareunia -dysuria and menstrual irregularities may occur -vaginal or cervical discharge -cervical excitation What investigations will you do for pelvic inflammatory disease - Answer -screen for Chlamydia and Gonorrhoea What is the management of pelvic inflammatory disease - Answer -due to the difficulty in making an accurate diagnosis, and the potential complications of untreated PID, consensus guidelines recommend having a low threshold for treatment oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole RCOG guidelines suggest that in mild cases of PID intrauterine contraceptive devices may be left in. The more recent BASHH guidelines suggest that the evidence is limited but that ' Removal of the IUD should be considered and may be associated with better short term clinical outcomes'
c. previous Caesarian section d. large cervical cone biopsy - Answer -large cervical cone biopsy What are the risk factors for miscarriages - Answer -- age:Women older than age 35 have a higher risk of miscarriage than do younger women. At age 35, you have about a 20 percent risk. At age 40, the risk is about 40 percent. And at age 45, it's about 80 percent. -previous miscarriages:Women who have had two or more consecutive miscarriages are at higher risk of miscarriage. -chronic conditions:Women who have a chronic condition, such as uncontrolled diabetes, have a higher risk of miscarriage. -uterine or cervical problems:Certain uterine abnormalities or weak cervical tissues (incompetent cervix) might increase the risk of miscarriage. -smoking, alcohol and illicit drugs:Women who smoke during pregnancy have a greater risk of miscarriage than do nonsmokers. Heavy alcohol use and illicit drug use also increase the risk of miscarriage. -weight:Being underweight or being overweight has been linked with an increased risk of miscarriage.
-invasive prenatal tests:Some invasive prenatal genetic tests, such as chorionic villus sampling and amniocentesis, carry a slight risk of miscarriage. What is a miscarriage - Answer -an abortion is the expulsion of the products of conception. the term miscarriage is used often to avoid any misunderstandings What is the epidemiology of miscarriage - Answer --5-20% of diagnosed pregnancies will miscarry in early pregnancies -non-development of the blastocyst within 14 days occurs in up to 50% of conceptions -recurrent spontaneous miscarriage affects 1% of women A pregnant woman at 11 weeks gestation has a miscarriage. Of these five factors, which one is most associated with miscarriage? a. obesity b. bumping the abdomen c.having sex d.heavy lifting e. stress - Answer -obesity Name the factors which are associated with increased risk of miscarriage - Answer --increased maternal age -smoking in pregnancy
