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🌸 Gynaecology · Part 3 revision hub
Reproductive‑endocrine disorders
Everything you need to revise this Part in one place — the one‑page note for every concept, a rapid‑revision sheet, exam‑style questions that point you back to the right concept, flashcards, staged cases and viva practice.
7 concepts15 MCQs15 flashcards4 cases12 viva questions
📝 The plate wall
Every concept in this Part as a one‑page handwritten note. Open one to read it in full and zoom.
⚡ Rapid revision
The whole Part on one screen — read it the night before.
Hyperandrogenism and PCOS
- Hirsutism is androgen-pattern terminal hair; hypertrichosis is diffuse non-androgenic hair; virilisation is severe androgen excess.
- Rapid onset, postmenopausal onset, virilisation, mass, very high testosterone or high DHEAS means tumour until excluded.
- Adult PCOS is 2 of 3 after exclusion: hyperandrogenism, ovulatory dysfunction, PCOM on ultrasound or elevated AMH.
- Adolescents need both persistent ovulatory dysfunction and hyperandrogenism; do not use ultrasound or AMH.
PCOS management
- No pregnancy desired: lifestyle support, endometrial protection, combined hormonal contraception, antiandrogen only with contraception.
- Pregnancy desired: optimise weight/metabolic factors, then letrozole first-line for ovulation induction.
- Screen PCOS beyond fertility: glucose risk, lipids, BP, sleep apnoea, mood, body image and endometrial risk.
Endometriosis, adenomyosis and fibroids
- Endometriosis: dysmenorrhoea, deep dyspareunia, infertility; pain does not match stage; endometrioma is chocolate cyst.
- Adenomyosis: heavy painful periods with bulky tender uterus.
- Fibroid rule: location beats size; submucosal causes bleeding/fertility issues, subserosal causes bulk.
Menopause and HRT
- Menopause: follicle depletion, low estradiol, high FSH; typical diagnosis is clinical after 12 months amenorrhoea.
- Postmenopausal bleeding always needs evaluation.
- Systemic estrogen plus intact uterus requires progestogen; transdermal estrogen has lower VTE risk than oral in appropriate candidates.
- Local vaginal estrogen treats GSM and is different from systemic HRT.
🎯 Single‑best‑answer MCQs
Pick an answer to see the explanation — and the concept to revisit if you missed it. Your answers are saved on this device.
Score 0 / 00 of 15 answered
Question 1
A 24-year-old has gradually progressive upper-lip and chin terminal hair since adolescence, regular cycles and normal testosterone/DHEAS. Which diagnosis is most likely?
Question 2
A woman develops severe hirsutism over 4 months with clitoromegaly. Which first step is most appropriate?
Question 3
According to the 2023 PCOS guideline, which is correct for diagnosing PCOS in adolescents?
Question 4
An adult has irregular cycles and clinical hirsutism after exclusion of mimics. What additional test is mandatory to diagnose PCOS?
Question 5
A woman with PCOS and anovulatory infertility needs first-line pharmacological ovulation induction. Which drug is preferred?
Question 6
Why must spironolactone for PCOS-related hirsutism be paired with reliable contraception?
Question 7
Which symptom cluster most strongly suggests endometriosis?
Question 8
Adenomyosis most classically presents with which finding?
Question 9
Which fibroid location is most associated with heavy menstrual bleeding and subfertility even when small?
Question 10
A pregnant patient with a known fibroid develops acute localised pain and low-grade fever. What is the classic fibroid complication?
Question 11
Which hormonal pattern best fits menopause?
Question 12
A 57-year-old has bleeding 3 years after her last period. What is the best interpretation?
Question 13
A woman with an intact uterus starts systemic estrogen for severe hot flushes. What must be added unless contraindicated?
Question 14
Which statement about local vaginal estrogen for GSM is most accurate?
Question 15
With modern transvaginal ultrasound in adults, the 2023 PCOS guideline uses which follicle threshold for PCOM?
🃏 Flashcards
Say the answer out loud before you flip. Shuffle once you know the order.
Card 1 of 15
🩺 Staged clinical cases
Read the presentation, decide what is going on and what you would do — then reveal the reasoning.
Case 1 — Rapid hair growth is not PCOS until proven
Stage A: A 34-year-old reports new chin and chest hair over 5 months, deepening voice and irregular periods.
Linked concepts: 16. Too Much Male Hormone: Hirsutism, 17. PCOS: the Whole Picture
Case 2 — PCOS patient wants pregnancy now
Stage A: A 27-year-old with oligomenorrhoea, acne and biochemical hyperandrogenism has been trying to conceive for 14 months.
Linked concepts: 17. PCOS: the Whole Picture, 18. Living Well with PCOS
Case 3 — Painful periods with infertility
Stage A: A 31-year-old has severe dysmenorrhoea, deep dyspareunia and 2 years of infertility; ultrasound shows a 4 cm ovarian cyst with ground-glass echoes.
Case 4 — Menopause symptoms but bleeding changes the priority
Stage A: A 55-year-old, 2 years postmenopausal, asks for HRT for hot flushes and vaginal dryness. She mentions two episodes of spotting.
Linked concepts: 21. Menopause: the Ovary Retires, 22. Helping the Body Through Menopause
🎤 Viva practice
Answer aloud as if an examiner asked you — then check the model points.
Viva 1
How do you distinguish hirsutism from hypertrichosis?
Viva 2
Name three tumour red flags in hirsutism.
Viva 3
What are the adult PCOS diagnostic criteria?
Viva 4
How is adolescent PCOS diagnosis different?
Viva 5
What is first-line ovulation induction in PCOS?
Viva 6
Why protect the endometrium in PCOS?
Viva 7
What is an endometrioma?
Viva 8
Give the classic adenomyosis clue.
Viva 9
Which fibroid location most causes bleeding?
Viva 10
What is the endocrine signature of menopause?
Viva 11
What is the key HRT rule with an intact uterus?
Viva 12
What is the red flag symptom after menopause?
Keep going
Educational only — not a substitute for clinical judgement, supervision, or local guidelines.