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General Gynaecology Quiz
47 Questions
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General Gynaecology Quiz

Created by
@WellMadeMossAgate1595

Questions and Answers

What is a common clinical presentation of red degeneration in fibroids during pregnancy?

  • Pain abdomen, nausea/vomiting, and fever (correct)
  • Difficulty breathing
  • Severe headaches
  • Increased appetite

    • Which finding on histopathological examination is indicative of a fibroid undergoing degeneration?

  • Loose pseudocapsule and soft texture (correct)
  • Increased cell density
  • Increased vascularity
  • Presence of necrosis without inflammation

    • Which factor is primarily responsible for the pathogenesis of red degeneration in fibroids?

  • Hormonal fluctuations
  • Thrombosis of blood vessels supplying the fibroid (correct)
  • Infection of the fibroid
  • Genetic mutations in fibroid tissue

    • What laboratory findings would likely be seen in a patient with red degeneration of a fibroid?

    <p>Increased erythrocyte sedimentation rate</p> Signup and view all the answers

    Which of the following is NOT a recommended management option for red degeneration of fibroids during pregnancy?

    <p>Myomectomy</p> Signup and view all the answers

    Which of the following is a characteristic of Pseudo Meig's syndrome?

    <p>Right sided pleural effusion</p> Signup and view all the answers

    What is the most common type of degeneration observed in fibroids?

    <p>Hyaline degeneration</p> Signup and view all the answers

    Which complication is not associated with pregnancy in the presence of fibroids?

    <p>Amenorrhea</p> Signup and view all the answers

    What type of degeneration is characterized by 'popcorn calcification' on an X-Ray?

    <p>Calcareous degeneration</p> Signup and view all the answers

    Which part of a fibroid is the least vascular and where degeneration begins?

    <p>Central</p> Signup and view all the answers

    Which type of fibroid is classified as Type 0 in the FIGO classification?

    <p>Totally inside the cavity and generally pedunculated</p> Signup and view all the answers

    What symptoms are associated with anterior cervical fibroids?

    <p>Irritation of the bladder</p> Signup and view all the answers

    How are Type 0 and Type 1 submucosal fibroids typically removed?

    <p>By hysteroscopic removal</p> Signup and view all the answers

    What is the primary investigation for submucous fibroids when considering them along with infertility?

    <p>Saline infusion sonography (SIS)</p> Signup and view all the answers

    Which of the following is NOT a type of extra-uterine fibroid?

    <p>Fibroid arising from the endometrium</p> Signup and view all the answers

    Which management approach is indicated for a patient with submucous fibroids type 0 or 1 and presenting with infertility?

    <p>Hysteroscopic myomectomy</p> Signup and view all the answers

    Which type of fibroid is the most common according to the provided classification?

    <p>Subserosal</p> Signup and view all the answers

    What is the management for bilateral cornual intramural fibroids when associated with infertility?

    <p>Laparoscopic myomectomy</p> Signup and view all the answers

    Which of the following statements about the management of symptomatic fibroids is NOT true?

    <p>Subserosal symptomatic fibroids are usually managed with surgery.</p> Signup and view all the answers

    In general management of fibroids, which condition is regarded as an exception requiring surgical management?

    <p>Bilateral cornual intramural fibroids associated with infertility</p> Signup and view all the answers

    What is the most common cause of heavy menstrual bleeding (HMB)?

    <p>Increased surface area of endometrium</p> Signup and view all the answers

    Which of the following can lead to subfertility due to impaired gamete transport?

    <p>Uterine contractility</p> Signup and view all the answers

    What is the primary symptom associated with submucosal fibroids?

    <p>Heavy menstrual bleeding</p> Signup and view all the answers

    Which of the following options is considered an endocrine symptom related to fibroids?

    <p>Hypercalcemia</p> Signup and view all the answers

    What type of fibroid is most commonly associated with painful symptoms?

    <p>Submucosal fibroid</p> Signup and view all the answers

    Which of the following symptoms is least likely to be associated with fibroids?

    <p>Severe back pain</p> Signup and view all the answers

    What is a recommended step to reduce blood loss during surgery (Sx)?

    <p>Perform surgery in the pre-ovulatory phase</p> Signup and view all the answers

    What is the purpose of clamping the bilateral uterine artery during myomectomy?

    <p>To minimize blood loss during surgery</p> Signup and view all the answers

    What percentage range represents the recurrence rate of fibroids post-myomectomy?

    <p>5-10%</p> Signup and view all the answers

    Which instrument is specifically mentioned for holding fibroids during surgery?

    <p>Myoma screw</p> Signup and view all the answers

    What is a potential complication following myomectomy concerning menstrual symptoms?

    <p>Continued menorrhagia post surgery</p> Signup and view all the answers

    What type of fibroid is most commonly observed in females?

    <p>Intramural fibroid</p> Signup and view all the answers

    Which hormones are directly associated with the development of fibroids?

    <p>Estrogen and Progesterone</p> Signup and view all the answers

    What effect does menopause have on fibroids?

    <p>Regresses</p> Signup and view all the answers

    Which of the following chromosomal anomalies is associated with fibroids?

    <p>Chromosomal translocations</p> Signup and view all the answers

    Which statement regarding the effect of oral contraceptive pills (OCP) on fibroids is true?

    <p>They have no effect on the size of fibroids</p> Signup and view all the answers

    What is the primary surgical option for a patient with a completed family who has fibroids?

    <p>Hysterectomy</p> Signup and view all the answers

    Which type of fibroid is most commonly associated with infertility?

    <p>Submucosal fibroid</p> Signup and view all the answers

    For a Type 0/1 submucosal fibroid, what is the recommended surgical management?

    <p>Hysteroscopic myomectomy</p> Signup and view all the answers

    What is a non-surgical management option for decreasing the size of fibroids?

    <p>GnRH agonists</p> Signup and view all the answers

    In which situation is Laparoscopic myomectomy indicated?

    <p>Type a or any type ≥ 5 cms</p> Signup and view all the answers

    Which of the following is NOT a first-line medication for managing intramural/subserosal fibroids?

    <p>GnRH agonist</p> Signup and view all the answers

    What is the preferred approach for myomectomy of a type 2 submucous fibroid measuring 5 cm or larger?

    <p>Laparoscopic myomectomy</p> Signup and view all the answers

    Which medication is associated with a side effect of hirsutism?

    <p>Danazol</p> Signup and view all the answers

    Under which condition would uterine artery embolization (UAE) be contraindicated?

    <p>Active pelvic inflammatory disease (PID)</p> Signup and view all the answers

    What is the principle behind magnetic resonance guided focused ultrasound (MRGFUS)?

    <p>High intensity ultrasound waves inducing coagulative necrosis of the fibroid</p> Signup and view all the answers

    Which of the following statements about second-line treatments for fibroids is correct?

    <p>Mifepristone is a second-line drug used for large fibroids.</p> Signup and view all the answers

    Study Notes

    General Gynaecology

    • Peri/postmenopausal women may experience a sudden increase in fibroid size, leading to pain.

    Histopathological Examination (HPE)

    • Fibroids can present as soft and loose with a pseudocapsule.
    • High mitotic activity is indicated with ≥10 mitoses per high-power field (HPF).

    Red Degeneration

    • Occurs during pregnancy, typically in the second trimester.
    • Caused by thrombosis in supplying blood vessels, leading to necrosis and peritoneal irritation.
    • Common symptoms include abdominal pain, nausea/vomiting, and fever.
    • Laboratory findings show elevated white blood cell count and erythrocyte sedimentation rate.

    Management of Red Degeneration

    • Conservative treatment includes analgesics, antiemetics, and intravenous fluids.
    • Antibiotics, termination of pregnancy, and myomectomy are contraindicated.
    • "Red" degeneration characterized by salmon pink appearance and fishy odor due to blood pigments.

    Types of Extra-Uterine Fibroids

    • Cervical Fibroid:
      • Anterior: irritates bladder; posterior: affects urethra, causing urinary frequency or retention.
    • Broad Ligament Fibroid:
      • True and pseudo types, may affect ureters depending on their location.

    FIGO Classification of Fibroids

    • Submucosal Fibroid Types:
      • Type 0: completely within the cavity, usually pedunculated
      • Type 1: at least 50% in cavity
      • Type a: less than 50% in cavity
    • Types 0 and 1 can be surgically removed hysteroscopically; others may require laparoscopic approaches.

    Clinical Presentation of Fibroids

    • Most common: Asymptomatic; if symptomatic, heavy menstrual bleeding is prevalent.
    • Additional symptoms may include dysmenorrhea, subfertility, and pressure symptoms.

    Causes of Heavy Menstrual Bleeding (HMB)

    • Increased endometrial surface area and vascularity due to elevated estrogen levels.
    • Submucosal fibroids are the most common cause.

    Causes of Subfertility

    • Distortion of uterine cavity impairs implantation and gamete transport.
    • Submucosal fibroids are a leading cause of subfertility.
    • Usually asymptomatic; acute symptoms may arise from torsion or red degeneration.

    Endocrine Effects

    • Potential symptoms include polycythemia, hypercalcemia, and increased prolactin levels.

    Pseudo Meigs' Syndrome

    • Associated with pedunculated fibroids, featuring right-sided pleural effusion and ascites.

    Pregnancy Complications

    • Increased risk of preterm labor, intrauterine growth restriction (IUGR), and abruptio placentae.

    Degeneration of Fibroids

    • Most common degeneration is hyaline degeneration, characterized by a homogeneous appearance.
    • Calcareous degeneration typically affects subserosal fibroids and gives a distinctive "popcorn" calcification appearance on X-ray.

    Investigations for Fibroids

    • Transvaginal sonography (TVS) is the investigation of choice for uterine fibroids.
    • Saline infusion sonography (SIS) is more effective for submucous fibroids.

    Management Strategies for Fibroids

    • Asymptomatic fibroids may be managed with observation.
    • Submucosal fibroids causing infertility typically require surgical intervention.
    • Medical management includes tranexamic acid and hormonal treatments; surgical options depend on the type and size of the fibroid.

    Surgical Options

    • Hysterectomy is indicated if family planning is complete; otherwise, myomectomy is performed to preserve fertility.
    • Various techniques are employed based on fibroid type and symptoms.

    Special Techniques

    • Uterine artery embolization is contraindicated in women wanting to conceive.
    • High-intensity focused ultrasound (HIFU) and magnetic resonance-guided focused ultrasound (MRGFUS) are non-invasive treatments.

    Overview of Fibroids

    • Benign tumors composed mainly of smooth muscle cells, often estrogen and progesterone dependent.
    • Most common pelvic tumors in females, and they regress post-menopause.
    • Intramural fibroids are the most common initial form.

    Classification of Fibroids

    • Anatomical classification includes intramural, submucosal, and subserosal types.

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    Description

    Test your knowledge on general gynaecology with a focus on fibroid complications, especially during peri/post-menopausal stages and pregnancy. This quiz covers histopathological findings, pathogenesis, and clinical presentations associated with red degeneration of fibroids.

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