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Abnormal Uterine Bleeding and Gynecological Conditions, Exams of Gynecology

Brunel University LondonGynecology

A comprehensive overview of various gynecological conditions related to abnormal uterine bleeding, including normal menstrual volume and duration, menorrhagia, metrorrhagia, causes of abnormal uterine bleeding, diagnostic criteria for pcos, risks associated with pcos in pregnancy, psychological components of pcos, differential diagnoses for abnormal uterine bleeding in adolescents and post-menopausal women, risk factors for endometrial hyperplasia/malignancy, diagnostic tests for abnormal uterine bleeding, treatment options for abnormal uterine bleeding, endometriosis, primary and secondary dysmenorrhea, adenomyosis, infertility, virilization, bacterial vaginosis, cervicitis, pelvic inflammatory disease, uterine fibroids, endometrial cancer, cervical cancer, and ovarian cancer. A wide range of gynecological topics, providing detailed information on the causes, symptoms, diagnosis, and management of these conditions.

Typology: Exams

2023/2024

Available from 07/29/2024

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Gynecology exam revision
questions and the correct
marking scheme
1. Normal menstrual volume and duration - Correct Answer 30mls for 3-7 days
2. How much vaginal bleeding during period will give iron deficiency? - Correct
Answer 60ml
3. Definition of menorrhagia - Correct Answer >80mls
4. Polymenorrhea - Correct Answer Interval <24 days
5. Decrease in length of time between menses
6. Anovular
7. Oligomenorrhea - Correct Answer Interval >35 days
8. Increase in length of time between menses
9. Menorrhagia - Correct Answer Regular prolonged (flow lasts >8 days) and/or
XS bleeding >80mls
10.May lead to anaemia
11.Metrorrhagia - Correct Answer Bleeding between periods
12.Irregular prolonged and XS bleeding
13.Causes of abnormal uterine bleeding in women of reproductive age - Correct
Answer PALM COIEN
14.Polyp
15.Adenomyosis
16.Leiomyoma
17.Malignancy + hyperplasia
18.Coagulopathy
19.Ovulatory dysfunction
20.Iatrogenic
21.Endometrial
22.Not yet classified - chronic inflammation/ AVMs
23.Rotterdam criteria - Correct Answer Diagnostic criteria for PCOS
24.Amneorrhea/oligomenorrhea
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Gynecology exam revision

questions and the correct

marking scheme

  1. Normal menstrual volume and duration - Correct Answer 30mls for 3-7 days
  2. How much vaginal bleeding during period will give iron deficiency? - Correct Answer 60ml
  3. Definition of menorrhagia - Correct Answer >80mls
  4. Polymenorrhea - Correct Answer Interval <24 days
  5. Decrease in length of time between menses
  6. Anovular
  7. Oligomenorrhea - Correct Answer Interval >35 days
  8. Increase in length of time between menses
  9. Menorrhagia - Correct Answer Regular prolonged (flow lasts >8 days) and/or XS bleeding >80mls
  10. May lead to anaemia
  11. Metrorrhagia - Correct Answer Bleeding between periods
  12. Irregular prolonged and XS bleeding
  13. Causes of abnormal uterine bleeding in women of reproductive age - Correct Answer PALM COIEN
  14. Polyp
  15. Adenomyosis
  16. Leiomyoma
  17. Malignancy + hyperplasia
  18. Coagulopathy
  19. Ovulatory dysfunction
  20. Iatrogenic
  21. Endometrial
  22. Not yet classified - chronic inflammation/ AVMs
  23. Rotterdam criteria - Correct Answer Diagnostic criteria for PCOS
  24. Amneorrhea/oligomenorrhea
  1. USS - ovarian size >10cc or 9-12 cysts on either ovary
  2. Clinical/biochemical signs of hyperandrogenism
  3. PCOS in pregnancy assoc with what risks? - Correct Answer PET
  4. GDM
  5. Macrosomia
  6. Reproductive components of PCOS - Correct Answer Oligomenorrhoea
  7. Subfertility
  8. Hyperandrogenism
  9. Psychological components of PCOS - Correct Answer Depression
  10. Anxiety
  11. Low self esteem
  12. Eating disorders
  13. Sexual dysfunction
  14. Ddx for abnormal uterine bleeding in adolescent - Correct Answer STI
  15. Pregnancy
  16. Anovulatory cycles
  17. Bleeding disorders
  18. DDx of post-menopausal bleeding - Correct Answer Atrophy
  19. Endometrial hyperplasia/cancer
  20. Polyp
  21. Chronic inflammation
  22. RFs for hyperplasia/malignancy in context of abnormal vaginal bleeding - Correct Answer Age
  23. obesity;
  24. chronic anovulation; underlying ovarian disease (PCOS, E2 producing tumours)
  25. infertility, nulliparity
  26. history of breast cancer; tamoxifen use;
  27. failure to respond to treatment for uterine bleeding
  28. exogenous hormone exposure - unopposed estrogen (and intact uterus): risk X 10
  29. hereditary non-polyposis colon cancer
  30. presence of glandular cells on pap smear
  31. presence of endometrial cells on pap smear post menopausal (1/3 will already have CA)
  32. family history of endometrial, ovarian, breast, or colon cancer
  33. Invx for abnormal uterine bleeding - Correct Answer bHCG - RULE OUT PREGNANCY
  34. FBC (anaemia, ITP)
  35. Fe studies + ferriten (IDA)
  1. Late childbearing
  2. Polymenorrhea
  3. Longer periods
  4. No use of hormonal contraception
  5. Primary dysmenorrhea - Correct Answer Menstrual pan assoc with ovulatory cycles in absence of pathological findings
  6. Low midline spasmodic pelvic pain that radiates to back or inner thighs
  7. Causes of primary dysmenorrhea - Correct Answer Uterine vasoconstriction
  8. Anoxia
  9. Sustained contractions
  10. All mediated by excess of of PGF2alpha (prostaglandins)
  11. Typical hx and exam findings suggesting primary dysmenorrhea - Correct Answer Low midline spasmodic pelvic pain that radiates to back or inner thighs
  12. Cramps occur in first 1-3 days of menstruation and assoc with nausea, diarrhoea, headache, flushing
  13. No pathological findings on exam
  14. When in cycle does primary dysmenorrhea occur and what symptoms are assoc with it? - Correct Answer First 1-3 days of menstrual cycle
  15. Nausea, diarrhoea, headache, flushing
  16. How is primary dysmenorrhoea diagnosed? - Correct Answer Dx of exclusion - rule out secondary dysmenorrhoea
  17. Treatment of primary dysmenorrhoea - Correct Answer NSAIDs
  18. COCs
  19. Mirena
  20. Topical heat therapy
  21. Define secondary dysmenorrhoea - Correct Answer Menstrual pain for which an organic cause exists
  22. Common causes of secondary dysmenorrhoea - Correct Answer Endometriosis, adenomyosis
  23. Fibroids
  24. Adhesions
  25. Polyps
  26. PID
  27. Pelvic examination findings in secondary dysmenorrhoea - Correct Answer Palpable uterine mass
  28. Cervical excitation
  1. Adnexal tenderness
  2. Vaginal/cervical discharge
  3. Visible pathology - tears, masses, prolapses
  4. Invx/WU for secondary dysmenorrhoea - Correct Answer bHCG - ectopic
  5. FBC - infection and neoplasm
  6. Urine - UTI
  7. Pelvic USS
  8. Swabs - chlamydia, gonorrhoea - PID, STI
  9. Define endometriosis - Correct Answer Functional endometrial glands and stroma outside the uterus
  10. Define adenomyosis - Correct Answer Endometrial tissue in the myometrium of the uterus
  11. Typical hx - endometriosis - Correct Answer Cyclical pelvic/rectal pain
  12. Dyspareunia
  13. Typical hx - adenomyosis - Correct Answer Classic triad - non-cyclical pain, menorrhagia, enlarged uterus
  14. Diagnosing endometriosis - Correct Answer Direct visual confirmation by laparoscopy
  15. Typical lesions seen in endometriosis - Correct Answer Blue-black (raspberry) or dark brown (powder-burned) appearance
  16. Ovaries may have endometriomas - chocolate cysts
  17. What are endometriomas? - Correct Answer Chocolate cysts seen in ovaries of someone with endometriosis
  18. Diagnosis adenomyosis - Correct Answer USS - but cannot distinguish between adenomyosis and leiomyoma
  19. MRI
  20. Pathological dx
  21. Treatment of endometriosis - Correct Answer Pharmacological - COC first line
  22. Conservative surgical treatment - lesions and adhesions
  23. Definitive surgical treatment - TAH/BSO
  24. Pharmacological treatment of endometriosis - Correct Answer Inhibition of ovulation
  25. COC - first line
  1. Postmenopausal bleeding is assumed as what dx before proven otherwise? - Correct Answer Cancer - usually endometrial
  2. Oligomenorrhoea hx and exam - Correct Answer Hx - Assess polymenorrhoea, oligomenorrhoea, menorrhagia, metrorrhagia
  3. Exam - Rule out cancer, fibroids, pregnancy
  4. Large uterus, cervical mass, polyps
  5. Invx in patient with DUB - Correct Answer bHCG - rule out ectopic pregnancy
  6. FBC - anaemia, WCC, malignancy
  7. Pap smear - r/o malignancy
  8. PT/APTT - r/o vWD, FXI deficiency
  9. USS - masses, PCOS, endometrial thickness
  10. TFTs - r/o hyper/hypo thyroidism and hyperPRL
  11. First line treatment of abnormal uterine bleeding - Correct Answer NSAIDs - reduce blood loss
  12. Treatment of heavy bleeding (emergency) - Correct Answer High dose estrogen IV stabilises endometrial lining and stops bleeding within 1 hour
  13. Heavy bleeding not controlled with high dose estrogen within 12-24 hours
- **_Correct Answer_** D&C
  1. Treatment for heavy ovulatory bleeding - Correct Answer NSAIDs
  2. OCP or Mirena
  3. Treatment for anovulatory bleeding (metrorrhagia) - Correct Answer Convert proliferative endometrium to secretory endometrium to prevent endometrial cancer
  4. Progestins for 10 days to stimulate withdrawal bleed
  5. OCP
  6. Mirena
  7. Desmopressin to increase vWF if needed
  8. Treatment for metrorrhagia caused by bleeding problem - Correct Answer Desmopressin to increase vWF
  9. Treatment for abnormal uterine bleeding if medical therapy fails - Correct Answer D&C
  10. Hysteroscopy - detect polyps, take biopsy
  11. Hysterectomy/endometrial ablation
  1. Women with abnormal uterine bleeding - when should endometrial biopsy be performed? - Correct Answer Post menopausal and endometrium >4mm thick

  2. 35 and obese, diabetic etc

  3. Complications of abnormal uterine bleeding - Correct Answer Anaemia
  4. Endometrial cancer
  5. 21 hydroxylase deficiency - Correct Answer Most severe form of CAH
  6. Presents as newborn female infant, ambiguous genitalia, life threatening salt wasting
  7. 11beta hydroxylase deficiency - Correct Answer Less common cause of CAH than 21 hydroxylase deficiency
  8. Presentation of CAH - Correct Answer Hirsutism
  9. Acne
  10. Amenorrhoea/abnormal uterine bleeding
  11. Infertility
  12. Palpable pelvic mass - rare
  13. What is CAH - Correct Answer Deficiency of enzyme required for synthesis of cortisol from cholesterol
  14. What is virilisation - Correct Answer Frontal balding
  15. Muscularity
  16. Clitoromegaly
  17. Deepening of voice
  18. What is defeminisation - Correct Answer Reduced breast size
  19. Loss of feminine adipose tissue
  20. ?CAH. Increased testosterone and DHEA. Must rule out... - Correct Answer Adrenal or ovarian neoplasm
  21. ?CAH. Increased serum testosterone. Must rule out... - Correct Answer Suspect ovarian tumour
  22. ?CAH. Increased DHEAS. Must rule out... - Correct Answer Adrenal tumour
  23. Cushings syndrome
  24. CAH
  25. Treatment of CAH - Correct Answer Glucocorticoids - prednisone - prevents new hair growth but does not resolve hirsutism (laser ablation etc)
  1. Define infertility - Correct Answer Inability to conceive after 12 months of normal, regular, unprotected sex
  2. Primary infertility - Correct Answer Infertility and no prior pregnancies
  3. Secondary infertility - Correct Answer Infertility in setting of at least 1 prior pregnancy
  4. Male causes of infertility - Correct Answer Primary hypogonadism - incr FSH (Turners, Klinefelter)
  5. Secondary hypoG - Kallmans, haemochromatosis, DM
  6. Disordered sperm transport
  7. Unknown
  8. Female causes of infertility - Correct Answer Ovulatory dysfunction/amenorrhoea
  9. Tubal defect
  10. Endometriosis
  11. Other
  12. Femal causes of infertility - ovulatory dysfunction - Correct Answer Hypothalamic/pituitary
  13. PCOS
  14. Premature ovarian failure
  15. Uterine or outflow tract disorders
  16. Invx for? male causes of infertility - Correct Answer TSH
  17. PRL
  18. Karyotype
  19. Semen analysis
  20. Treatment for male causes of infertility - Correct Answer Intrauterine insemination
  21. Treatment of hormonal deficiency
  22. Donor insemination
  23. IVF
  24. Intracytoplasmic sperm injection
  25. Define vaginitis - Correct Answer Collections of conditions causing vaginal itching, burning, irritation and abnormal discharge
  26. Most common causes of vaginitis - Correct Answer Bacterial vaginosis
  27. Vulvovaginal candidiasis
  28. Trichomoniasis
  29. STI
  1. Presentation of vaginitis - Correct Answer Change in normal discharge
  2. Malodour
  3. Itching
  4. Irritation
  5. Burning
  6. Dyspareunia
  7. Swelling
  8. Dysuria
  9. Normal vaginal secretions - Correct Answer Clear elastic mucoid secretion - midcycle estrogen surge
  10. Thick white secretions adhering to vaginal wall - luteal phase/pregnancy
  11. Vaginitis, smear shows many WCCs and no organism - Correct Answer Chlamydia
  12. Criteria for diagnosis of bacterial vaginosis - Correct Answer AbN whitish grey DC
  13. Vaginal pH>4.
    • whiff test
  15. Clue cells
  16. Invx for? vaginitis - Correct Answer Cervical fluid for vaginal pH, amine whiff test, wet mount, KOH microscopy
  17. Purulent DC, cervical friability, symptoms of PID - Correct Answer Order DNA tests or cultures for chlamydia and gonorrhoea to rule out cervicitis
  18. Cervicitis - Correct Answer Inflammation of uterine cervix
  19. Aetiology of cervicitis - Correct Answer Infectious - chlamydia, gonnorrhoea, trich, HSV, HPV
  20. Non-infectious - trauma, radiation, malignancy
  21. Typical presentation of cervicitis - Correct Answer Yellow/green DC
  22. Cervical excitation
  23. No other signs of PID
  24. Chandelier sign - Correct Answer Severe cervical motion tenderness that makes patient jump for chandelier on examination
  25. What is PID - Correct Answer Pelvic inflammatory disease
  26. Polymicrobial infection of upper genital tract.
  1. Drainage of tubo-ovarian abscess
  2. Exploratory laparotomy
  3. PID complications - Correct Answer Recurrent infection, chronic pelvic pain, dyspareunia, ectopic
  4. Infertility
  5. Fitz-Hugh-Curtis syndrome
  6. Abrupt onset fever, vomiting, watery diarrhoea,macular erythematous rash, non-purulent conjunctivitis, desquamation of palms and soles during recovery - Correct Answer Toxic Shock Syndrome
  7. Occurs within 5 days of onset of menstrual period in women using tampons
  8. Uterine myoma malignant or benign? - Correct Answer Benign
  9. Can cause menorrhagia, infertility
  10. Malignant transformation can occur but is rare - 0.1-0.5%
  11. Uterine fibroids and hormone sensitivity - Correct Answer Estrogen and progesterone sensitive
  12. Increase in size in pregnancy, decrease in size in menopause
  13. Most fibroids symptomatic or not? - Correct Answer Majority asymptomatic
  14. Typical presentation of symptomatic fibroids - Correct Answer Bleeding - menorrhagia
  15. Pressure - bloating, constipation, rectal pressure, urinary frequency or retention
  16. Pain - secondary dysmenorrhea, dyspareunia
  17. Examination - fibroids - Correct Answer Firm, non-tender, irregularly enlarged uterus
  18. Cobble-stone uterus
  19. Invx for? fibroid - Correct Answer FBC - anaemia
  20. USS - exclude ovarian mass
  21. MRI - intramural vs submucosal fibroid
  22. Treatment of uterine fibroids - Correct Answer NSAIDs
  23. COC
  24. Danazol to stop bleeding
  25. GnRH analogues - reduce meioma size, prior to surgery
  26. Surgery
  27. Surgery for fibroids - Correct Answer Reproductive:
  1. Hysteroscopic myomectomy
  2. Menopausal/don't want chidren:
  3. Total or subtotal abdo or vaginal hysterectomy
  4. Uterine artery embolisation
  5. Complications of fibroids - Correct Answer Infertility - distorts uterine cavity
  6. What % of women with endometrial cancer get PV bleeding - Correct Answer 80%
  7. What % of women with PV bleeding have endometrial cancer - Correct Answer 5-10%
  8. Presentation endometrial cancer - Correct Answer PV bleeds - early
  9. Pain - late
  10. Metabolic syndrome
  11. Invx endometrial cancer - Correct Answer Endometrial/endocervical biopsy
  12. USS - thickened endometrium
  13. Treatment of endometrial cancer - Correct Answer Child-bearing age - high dose progestins
  14. PostM - TAH/BSO + radiation
  15. TAH/BSO + chemo if advanced
  16. T/F: hormonal contraceptives are protective against endometrial cancer - Correct Answer True
  17. HPV strain most prevalent in squamous cell carcinoma - Correct Answer 16
  18. HPV strain most prevalent in adenocarcinoma - Correct Answer 18
  19. RFs for cervical cancer - Correct Answer HPV infection
  20. Multiple sexual partners
  21. Early age at first sexual intercourse
  22. Immunosuppression
  23. STDs
  24. Smoking
  25. High parity
  26. OCP
  27. Vaccine against HPV and cervical cancer - Correct Answer Gardasil
  1. Treatment of stage 1A1 microinvasive cervical carcinoma - Correct Answer Cone biopsy OR
  2. hysterectomy
  3. Treatment of 1A2, 1B1, 2A cervical cancer - Correct Answer Radical hysterectomy, chemo and radiation OR
  4. ChemoT and radiation alone
  5. Treatment of 1B2, 2B, 3, 4 cervical cancer - Correct Answer Radiation plus cisplatin based chemoT
  6. Overall relative 5 year survival rate for cervical cancer , stage 0, stage and stage 5 - Correct Answer 68% for Caucasian
  7. 0 - 99-100%
  8. 1 - >95%
  9. 4 - <20%
  10. What do most patients with untreated cervical cancer die of - Correct Answer Uraemia due to bilateral ureteral obstruction
  11. What is leading cause of death from reproductive tract cancer? - Correct Answer Malignant ovarian cancer
  12. RFs for malignant ovarian cancer - Correct Answer Age
  13. Low parity
  14. Reduced fertility
  15. Delayed childbearing
  16. FHx
  17. BRCA 1 - 45%
  18. BRCA 2 - 25%
  19. HNPCC/Lynch syndrome (colon, ovarian, endometrial, breast)
  20. Effect of OCP on ovarian cancer - Correct Answer Reduces risk by 30% if taken for 5 years
  21. Typical presentation of ovarian malignancy - Correct Answer Usually asymptomatic
  22. Mild GI sx, pelvic pressure or pain
  23. 75% present with advanced dz - abdo pain, bloating, abdo mass, ascites
  24. Any palpable adnexal mass in premenarchal or post menopausal women - Correct Answer Suggestive of ovarian neoplasm
  25. Invx for? ovarian cancer - Correct Answer Tumour markers - CA
  26. Transvaginal USS
  1. What type of cancer makes up 90% of ovarian cancers - Correct Answer Epithelial cell cancers
  2. Increased CA125 in postmenopausal women - Correct Answer May indicate benign dz such as endometriosis
  3. May also indicate that if ovarian cancer present, more likely to be malignant than benign
  4. Treatment of ovarian mass >2cm in premenarchal girl - Correct Answer Close FU + likely surgical removal
  5. Mobile, unilateral, simple cystic ovarian mass <8-10cm in postmenopausal women - treatment - Correct Answer Observation - most resolve spontaneously
  6. Complex ovarian mass >8-10cm in postmenopausal women - Correct Answer Surgical evacuation
  7. Treatment of ovarian cancer - Correct Answer TAH/BSO with omentectomy +pelvic and para-aortic lymphadenectomy
  8. Benign - tumour removal or unilateral oophorectomy
  9. Post-op chemoT for low grade
  10. Radiation for dysgerminomas
  11. Screening for ovarian cancer - Correct Answer For women with BRCA 1 - USS and CA125 annually
  12. Prophylactic oophorectomy recommended when >35 or finished having kids
  13. OCP use reduces risk of ovarian cancer