Gynae

• What does unopposed oestrogen increase the risk of in HRT?

  Endometrial cancer
• What does adding a progestogen in HRT increase the risk of?

  Breast cancer
• When is contraception needed after menopause for women over 50?

  12 months after the last period
• When is contraception needed after menopause for women under 50?

  24 months after the last period
• What is the first-line treatment for menorrhagia?

  Intrauterine system (Mirena)
• What is smoking associated with regarding hyperemesis gravidarum?

  Decreased incidence
• What is the gold-standard investigation for suspected endometriosis?

  Laparoscopy
• What are the classic symptoms of endometriosis?

  Pelvic pain, dysmenorrhoea, dyspareunia, subfertility
• What score classifies the severity of nausea and vomiting in pregnancy?

  Pregnancy-Unique Quantification of Emesis (PUQE) score
• What are the diagnostic criteria for hyperemesis gravidarum?

  5% weight loss, dehydration, electrolyte imbalance
• What is atypical hyperplasia of the endometrium classified as?

  Premalignant condition
• What causes endometrial hyperplasia?

  Unopposed oestrogen
• What is a risk factor for endometrial hyperplasia?

  Tamoxifen
• What is illegal regarding type 3 FGM after vaginal delivery?

  Reinfibulation
• How long is the Mirena intrauterine system licensed for HRT use?

  4 years
• When should ovarian cancer be suspected in women over 50?

  Symptoms suggestive of IBS in last 12 months
• What should be done for women over 55 with postmenopausal bleeding?

  Refer using suspected cancer pathway
• Is blood testing required to confirm menopause?

  No, it's a clinical diagnosis
• What is advisable for postmenopausal women with atypical endometrial hyperplasia?

  Total hysterectomy with bilateral salpingo-oophorectomy
• What characterizes a threatened miscarriage?

  Bleeding with a closed cervical os
• How may endometrial hyperplasia present?

  Intermenstrual bleeding, post-menopausal bleeding, menorrhagia, irregular bleeding
• How does smoking affect cervical cancer risk?

  Increases risk two-fold
• What should be done regarding female genital mutilation in under 18s?

  Report to police
• What ultrasound sign may indicate ovarian torsion?

  Whirlpool sign
• Why is cervical ectropion more common in COCP users?

  Higher oestrogen levels
• What is a risk factor for second-trimester miscarriage?

  Large cervical cone biopsy
• What is the first-line non-hormonal treatment for menorrhagia?

  Tranexamic acid
• What is the first-line treatment for primary dysmenorrhoea?

  NSAIDs such as mefenamic acid
• What should be done for all patients with secondary dysmenorrhoea?

  Refer to gynaecology for investigation
• What can be bypassed if there is suspicion of ovarian cancer with an abdominal mass?

  CA125 and ultrasound tests
• What are the criteria for expectant management of an ectopic pregnancy?

  Unruptured, <35mm, no heartbeat, asymptomatic, B-hCG <1,000IU/L and declining
• What is the medical management for an incomplete miscarriage?

  Vaginal misoprostol alone
• What do low-level gonadotrophins indicate in secondary amenorrhoea?

  Hypothalamic causes
• What is a common cause of secondary amenorrhoea in very athletic women?

  Hypothalamic hypogonadism
• What is a leading differential diagnosis for primary amenorrhoea in a teenager with painful cycles?

  Imperforate hymen
• What does a complete hydatidiform mole present with?

  Uterus size greater than expected, high serum hCG
• What ultrasound appearance is associated with hydatidiform mole?

  Snow storm appearance
• What is the drug of choice for medical management of ectopic pregnancy?

  Methotrexate
• Where is the most common site of ectopic pregnancy?

  Ampulla of fallopian tube
• When is expectant management of miscarriage not suitable?

  Evidence of infection or increased risk of haemorrhage