Gynae Past Paper Scenarios

SECTION B -GYNAE PAST PAPER
SCENARIO 1
SCENARIO 1 ANSWERS
1a) 8 Causes of vaginal discharge
-Vulvovaginal candidiasis
-Trichomoniasis
-Bacterial vaginosis
-Gonorrhoea
-Genitourinary chlamydia
-PID
-Female genital tract Schistosomiasis

-Genital Tuberculosis
1b) The picture shows clue cells which is suggestive the pt has Bacterial Vaginosis.
1c) The criteria used is Amsel’s Criteria:
At least three out of four criteria for diagnosing BV
1. Presence of clue cells on microscopic examination.
2. Creamy greyish white discharge which is seen on naked eye examination.
3. Vaginal pH of more than 4.5.
4.WHIFF TEST: Release of a characteristic fishy odour on addition of 10% KOH
1d). You tell her that BV is not sexually transmitted. She did not get it from her husband, rather
it is due to marked decrease in lactobacilli (normal vaginal flora)/vaginal douching.
1e). Possible causes at this time are: -Vulvovaginal candidiasis & Trichomoniasis
1f) Other investigations to Order: FBC/DC, HIV Test and Pelvic Ultrasound
1g) Description of picture: The picture shows Candida albicans branching pseudo hyphae and
budding yeast cells on a wet mount Potassium Hydroxide (KOH).
Diagnosis: Vulvovaginal Candidiasis
1h) Treatment: Clotrimazole cream or vaginal pessary 100mg nocte for 6 days or Fluconazole
150mg PO stat.
1 i) Diagnosis now changes to: Recurrent Vulvovaginal Candidiasis
1j). Proposed plan of management:-Induction Regimen: Fluconazole 150 mg is given in three

doses orally every 72 hours &Maintenance Regimen: Fluconazole 150 mg weekly for six months
SCENARIO 2
2a) Causes of AUB in this girl: Coagulopathy, Ovulatory Dysfunction & Iatrogenic
2b). Abnormalities on hemogram:
-White Cell count is low
-Red cell count is low
-Platelet Count is low
-Mean platelet volume is low
-Platelet Distribution width is low
2c). Haematological Diagnosis Pancytopenia
2d) Other investigations to order:
-Peripheral Blood Smear
-Clotting time
-Prothrombin time & APPT
-Clotting factors
2e). Three haemostatic mechanisms:
1.Vasoconstriction via PGF2 alpha, Endothelin-1, PAF( all this is due to Progesterone
withdrawal).
2. The cyclooxygenase (COX)-2 enzyme and chemokines are involved in prostaglandin synthesis
that inhibit platelets
3.Local aggregation of platelets with deposition of fibrin around them.
2.f) Drugs targeting above mechanisms:
1. Drug targeting hormone: Medroxyprogesterone acetate 5 -10mg on day 16-28 of the cycle.
2. Drug targeting Prostaglandin Synthesis: -Mefenamic Acid 500mg TDS PO 5/7.
3. Anti-Fibrinolytic: -Tranexamic Acid 500mg to 1000mg TDS on day 3 to day 5 of the period.
2g) Since medical management has failed institute surgical management:
-Uterine Tamponade: Insert a Foley Catheter in the uterus and inflate the balloon with 10-20 mls of
NS. If that fails, perform emergency MVA or D &C (send tissue for histopathology). Last resort is
Hysterectomy.
SCENARIO 3
3A). Uterus length is reduced (normal is 7.5cm)

SCENARIO 3 CONT’
SCENARIO 3 ANS
3b). Working Diagnosis is Polycystic Ovarian Syndrome (PCOS)
3C). Other tests to do: Random Blood Sugar, IGF-1.
3D). Long-term Complications: Type 2 DM, Cardiovascular Disease, Endometrial Cancer.
3 E). Clomiphene Citrate MOA: acts as an anti-oestrogen at the oestrogen receptors of the
hypothalamus & pituitary.
3F). Microgynon
3G). Gestational age =12mm+28/7 = 5 wks 5 days
3H). Threatening Miscarriage
3I). Missed Miscarriage

3J.) -Counsel the woman on loss of pregnancy.
Mx; - 1. Expectant Management.
-2. Medical Management: - GA<14 Weeks; Misoprostol 800mcg PO/PV or 600 mcg SL; repeat after
3 hours
-GA of 14-17 weeks: Misoprostol 200mcg PV QID, max of 4 doses.
-GA of 18-28 weeks: Misoprostol 100mcg PV QID, max of 4 doses
-3Surgical Management: Evacuation: - MVA if GA < 14 weeks. Give Misoprostol 400mcg 3 hours
before MVA. Cervical Block and Analgesia
-Bereavement and Family Planning counseling.

3 K). Management of Luteal Phase Deficiency: Class of drugs used is Progesterones e,g Micronized
Progesterone
SCENARIO 4
SCENARIO 4 ANS
4 A). Yellow sandy patches are seen in Genital Schistosomiasis
4B). Complications of condition in (a): Infertility, Contact Bleeding, Preterm Labour, Stress
incontinence, Genital Ulcers & Tumours/swellings
4C). FIGO Stage IIA for Cervical Cancer.
4D). FIGO Stage IIIB for Endometrial Cancer

4E). HL-SIN
SCENARIO 4 CONT’
4F). Two Modalities:
1. Brachytherapy (High Dose Radiation)

2.Teletherapy (External Beam Radiation)
4G). Chemotherapy is given in order to make the tumour radiosensitive
4 H). Four Prognostic Factors:
1.Age
2.Histological Type
3. Stage of the Tumour

4.Grade of differentiation
PEACE & LOVE

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SECTION B -GYNAE PAST PAPER

-Female genital tract Schistosomiasis

1c) The criteria used is Amsel’s Criteria:

At least three out of four criteria for diagnosing BV

1. Presence of clue cells on microscopic examination.

2. Creamy greyish white discharge which is seen on naked eye examination.

3. Vaginal pH of more than 4.5.

4.WHIFF TEST: Release of a characteristic fishy odour on addition of 10% KOH

Diagnosis: Vulvovaginal Candidiasis

1 i) Diagnosis now changes to: Recurrent Vulvovaginal Candidiasis

1j). Proposed plan of management:-Induction Regimen: Fluconazole 150 mg is given in three

2b). Abnormalities on hemogram:

-White Cell count is low

-Red cell count is low

-Platelet Count is low

-Mean platelet volume is low

-Platelet Distribution width is low

2c). Haematological Diagnosis Pancytopenia

2d) Other investigations to order:

-Peripheral Blood Smear

-Prothrombin time & APPT

3.Local aggregation of platelets with deposition of fibrin around them.

2.f) Drugs targeting above mechanisms:

2g) Since medical management has failed institute surgical management:

3A). Uterus length is reduced (normal is 7.5cm)

3b). Working Diagnosis is Polycystic Ovarian Syndrome (PCOS)

3C). Other tests to do: Random Blood Sugar, IGF-1.

3D). Long-term Complications: Type 2 DM, Cardiovascular Disease, Endometrial Cancer.

3H). Threatening Miscarriage

3I). Missed Miscarriage

Mx; - 1. Expectant Management.

-GA of 14-17 weeks: Misoprostol 200mcg PV QID, max of 4 doses.

-GA of 18-28 weeks: Misoprostol 100mcg PV QID, max of 4 doses

-Bereavement and Family Planning counseling.

4 A). Yellow sandy patches are seen in Genital Schistosomiasis

4C). FIGO Stage IIA for Cervical Cancer.

4D). FIGO Stage IIIB for Endometrial Cancer

4F). Two Modalities:

1. Brachytherapy (High Dose Radiation)

4G). Chemotherapy is given in order to make the tumour radiosensitive

4 H). Four Prognostic Factors:

3. Stage of the Tumour

PEACE & LOVE

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