Gynecological Emergencies.

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You see a young lady who you believe has Staph toxic shock syndrome from a retained tampon. Which of the following treatment combinations sounds best?

Caused by a Staph exotoxin. The patient needs aggressive resuscitation with removal of the offending tampon. IV Flucloxaciilin or Cephazolin does not affect the toxin but does decrease the bacterial load and therefore decrease ongoing toxin formation. Use Vancomycin if the patient is allergic to Penicillin. It is not known exactly what advantage adding Clindamycin (a protein synthesis inhibitor) has but most add it. The mechanism how immunoglobulin works is uncertain.

Resuscitate. IV Fluids. Benzyl Penicillin 2.4gms IV. Remove tampon. O and G ward.

Resuscitate. Clindamycin 40mg/kg/day IV. Remove tampon. Hydrocortisone 100mg IV. ICU.

Resuscitate. Remove tampon. Flucloxacillin 50mg/kg IV. Clindamycin. Immunoglobulin 2gm/kg IV. ICU.

Resuscitate. Remove tampon. Vancomycin 1gm IV. Immunoglobulin 2gm/kg IV. ICU.

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A lady with known fibroids presents with suprapubic pain. Which of the following is NOT a complication of fibroids than may have caused this presentation?

Red degeneration is a haemorrhagic infarction in a fibroid with increased prevelance during pregnancy.

I made up "Brown degeneration".

Torsion if the fibroid is pedunculated.

Necrosis if the fibroid has outgrown it's blood supply.

"Red Degeneration" of the fibroid especially if the lady is pregnant.

"Brown Degeneration" of the fibroid especially if the lady is pregnant.

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Which of the following should NOT be used in a patient with menorrhagia causing haemodynamic compromise?

Requires early gynecological involvement. Uterine tamponade with a 26 Foley is recognised as a possible additional temporising measure before OT but I have never performed it.

Hydrocortisone 100mg IV.

Premarin 25mg IV (conjugated estrogens).

Tranexamic acid 1gm IV.

Packed cells IV.

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What is a "frozen pelvis"?

An incapacitating complication of advanced endometriosis.

One of the recognised complications of moderate hypothermia treated with warm bladder irrigation.

When there is severe osteoarthritis "freezing" the pelvis to the lumbar spine.

A phrase used to describe the pelvis of a woolly mammoth found in the Siberian ice.

Because of severe endometriosis the pelvic organs are adherent to each other.

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The CT images are from a lady who presented with fever, lower abdominal pain and vaginal discharge. She has an IUD in place. What is the most likely diagnosis?

IUDs are a risk factor for developing pelvic inflammatory disease which can be complicated by tubo ovarian abscesses as seen here.

Most of the time you are more likely to see someone who has had previous pelvic inflammatory disease (without an IUD in position) that is complicated by an abscess. Not surprisingly the abscesses are polymicrobial with a preponderence of anaerobic organisms. A ruptured tubo ovarian abscess can cause death from sepsis.

Salpingitis.

Tubo ovarian abscess.

Diverticulitis with a fistula.

Endometritis.

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According to a 2023 survey by the Australian Bureau of Statistics what percentage of Australian women report experiencing sexual assault.

And stunningly according to the UN, 60% of 15 to 49yr old women in Papua New Guinea report physical sexual violence. This is twice the global average.

5%.

20%.

40%.

74%.

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Which of the following is NOT TRUE about Chlamydia genital infections in women?

Doxycycline 100mg bd for 7 days is the recommended antibiotic regime. Azithromycin 1gm orally stat is also an option especially in those patients where compliance may be an issue.

It is the most commonly reported sexually transmitted disease in Australia.

It is frequently asymptomatic.

The NAAT (Nucleic Acid Amplification Test) is a sensitive swab test for Chlamydia.

Phenoxymethyl Penicillin orally for 5 days is the best choice of antibiotic to treat genital Chlamydia.

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What is the most important Emergency Department treatment of "cervical shock"?

Hypotension and bradycardia occurs because of cervical dilation created by retained products of conception in an incomplete miscarriage. This causes vagal stimulation. Removal of the products of conception in the ED usually rapidly reverses the problem.

Change to a soft cervical collar.

Adrenaline 0.5mg IM.

Removal of the products of conception from the cervix.

Local compression over the cervix.

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In gynecology what is the PALM-COEIN classification used for?

STRUCTURAL

P--Polyps A--Adenomyosis L--Leiomyomata (fibroids) M--Malignancy and hyperplasia.

NON STRUCTURAL

C--Coagulopathy O--Ovulatory dysfunction E--Endometrial I--Iatrogenic N--Not yet classified

Used to classify abnormal PV bleeding in non pregnant patients into structural and non structural causes.

Used to classify ovarian cysts with regard to size and malignant potential.

Used to classify the chances of fibroids becoming malignant.

Used to classify the chance of becoming pregnant in patients with endometriosis

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Which of the following is the most common cause of admissions to gynecology wards in the developing world?

Unsafe abortions kill 70,000 women a year globally and the complications of unsafe abortions make up a great number of inpatient gynecology admissions.

Acute pelvic inflammatory diseases.

Complications from unsafe abortions.

Miscarriages.

Tubo ovarian abscesses.

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