EBCOG Part-1 General Gynaecology- Day 2(E.M.Q)

A. Tranexamic acid
B. Danazol
C. Mefenamic acid
D. Trans-cervical resection of fibroid
E. Combined oral contraceptive pill
F. Hysteroscopy + polypectomy
G. Fibroid embolisation
H. GnRH analogues
I. Levonorgestrel IUS
J. Pipelle endometrial biopsy

Instructions:For each scenario described below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

1.A 17 year old woman complains of painful periods since menarche which are now interfering with her studies. She is not sexually active and does not wish to take contraceptives.

2. A 30 year old mother of 2 children complains of heavy regular periods that were improved by cyclical progestogens. She has, however, discontinued treatment because of weight gain. She was sterilised 2 years ago.

A Sequential combined HRT
B Danazol
C TAH + BSO
D Trans-cervical resection of fibroid
E Combined oral contraceptive pill
F Hysteroscopy + polypectomy
G Fibroid embolisation
H GnRH analogues
I Levonorgestrel IUS
J Pipelle endometrial biopsy

Instructions:For each scenario described below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

3. A 30 year old woman complains of a 2 year history of progressively heavy periods. She was on the oral contraceptive pill until 3 years ago when she developed a DVT during pregnancy. Clinical examination is normal and she does not wish to take tablets.

4. A 43 year old mother of 5 children complains of a 5 year history of progressively heavy that have failed to respond to medical treatment. Trans-vaginal ultrasound scan performed in the proliferative phase shows a normal pelvis with a regular 14mm endometrium

A. Myomectomy
B. Danazol
C. TAH + BSO
D. Trans-cervical resection of fibroid
E. Combined oral contraceptive pill
F. Hysteroscopy + polypectomy
G. Fibroid embolisation
H. GnRH analogues
I. Levonorgestrel IUS
J. Hysteroscopy + polypectomy

5. A 35 year old woman has been trying for a pregnancy for 12 months and complains of heavy periods. Clinical examination and pelvic ultrasound scan confirm the presence of a 15 weeks size fibroid uterus but no other abnormalities.

6. A 45 year old mother of 4 children complains of progressively heavy but regular periods. Clinical examination shows a 15 weeks size fibroid uterus and endometrial biopsy showed proliferative endometrium. Medical therapy has failed but she does not wish to have major surgery.

7. A 35 year old mother of 4 children complains of progressively heavy periods. Over the last 2 Question 3 months, she has bled severely and required admission for blood transfusion. She has been listed for total abdominal hysterectomy in 3 months time.

A Danazol
B Endornetrial ablation
C Etamsylate
D Gonadotrophin-releasing hormone agonist
E Gonadotrophin-releasing hormone analogue and total abdominal hysterectomy and bilateral salpingo-oophorectomy and Add-back therapy
F Hysterectomy
G Injected progestogen
H Laparoscopic hysterectomy and bilateral salpingo-oophorectomy
I Levonorgestrel intrauterine system {LNG-1US)
J Luteal phase oral progestogens
K Myomectomy
L Non-steroidal anti-inflammatory drugs (NSAIDS)
M Oophorectomy at the time of hysterectomy
N Oral progestogens
0 Total abdominal hysterectomy and bilateral salpingo-oophorectomy
P Total abdominal hysterectomy and bilateral salpingo-oophorectomy and lymphadenectomy
Q Tranexamic acid.
R Ulipristal acetate
S Uterine artery embolization
T- Ulipristal acetate 5 mg for up to 4 courses

Instructions: For each of the patients detailed below, select from the above option list the single most appropriate next treatment you will offer for heavy menstrual bleeding. Each option may be chosen once, more than once or not at all.

8. A 30-year-old woman presents with heavy menstrual bleeding. Her periods occur every 30 days and are heavy and prolonged, associated with significant dysmenorrhea. She has had one normal vaginal delivery. A bulky uterus is suspected on bimanual examination. You initiate investigations including an ultrasound scan and FBC.

9. A 35-year-old mother of three children has been seen in the Gynaecology Clinic with heavy menstrual bleeding of 3 years duration. Her Hb analysis performed at the GP's surgery is 100 g/L. You examine and suspect small uterine fibroids. She is not hypertensive and does have any associated dysmenorrhea. You request for an ultrasound scan.

10.An ultrasound scan has been performed on a 37-year-old woman who has presented with heavy menstrual bleeding, Her Hb on presentation was 102 giL The ultrasound scan shows a fibroid measuring 5 cm in diameter. This is intramural but is pushing slightly into the endometrium.

11. A 40-year-old woman who was sterilized 4 years ago has returned for follow-up after having been on various pharmaceutical treatments for heavy menstrual bleeding for 2 years. At this review visit., she indicates that she continues to bleed heavily. An ultrasound scan has been performed and this shows adenomyosis.