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MFSRH > 4 - Gynaecology > Flashcards

4 - Gynaecology Flashcards

1
Q

Steps for administering an intracervical block

A

2ml mepivicaine in dental syringe
Inject 0.2ml under skin of anterior lip at 12 o’clock
Apply tenaculum to anterior lip
Insert needle at 3 o’clock into external os - parallel to canal
Withdraw and inject 0.9 ml
Insert needle at 3 o’clock into external os - parallel to canal
Withdraw and inject 0.9 ml
Wait 2 mins

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2
Q

Risk factors for HPV

A 
Increased number of sexual partners
Persistent infection
Immunocompromise
Higher viral load
Cigarette smoking
Lower socio-economic status
Prolonged use of COCP
Higher number of pregnancies
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3
Q

How to protect against HPV infection

A

Condom use
Late first pregnancy
(Gardasil)

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4
Q

Cell type of ectocervix

A

Non-keratinising stratified squamous epithelium

Resistant to low vaginal PH

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5
Q

Cell type of endocervix

A

Mucin-secreting columnar epithelium

Undergoes squamous meta plasma when exposed to vaginal PH

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6
Q

What is the transformation zone of the cervix

A

Where columnar epithelium has undergone metaplasia to become squamous epithelium.
Area between old and new squamo-columnar junction.

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7
Q

Cytological feature of cervical dyskaryosis

A

Increased nuclear:cytoplasmic ratio
Mitotic figures
Nuclear pleomorphism
Nuclear hyperchromasia

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8
Q

Cytological features of cervical HPV infection

A

Koilocytosis
Hyperkeratosis
Multinucleation

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9
Q

Depth of changes in CIN1

A

Changes in basal 3rd of epithelium

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10
Q

Depth of changes in CIN2

A

Basal 2/3 of epithelium

More marked nuclear atypia

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11
Q

Depth of changes in CIN3

A

Entire epithelium

More severe changes

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12
Q

Incidence of endometriosis

A

10-20% in F of reproductive age

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13
Q

what is endometriosis

A

Extrauterine endometrial stromal and glandular tissue.

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14
Q

Theories on pathophysiology of endometriosis

A
  1. retorgrade menstruation
  2. coelomic metaplasia
  3. haematogenous or lymphatic dispersion
  4. immunological dysfunction
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15
Q

cyclical pattern of endometriosis

A

Respond to cyclical changes in oestrogen and progesterone.
Proliferation, shedding and bleeding.
In turn leads to inflammation, fibrosis, adhesions and scarring (and reportedly pelvic pain).

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16
Q

Diseases which frequently co-exist with endometriosis

A

fibromyalgia, chronic fatigue syndrome, IBS.

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17
Q

Symptoms of endometriosis

A

Incidental finding
Chronic or cyclical pelvic pain
Subfertility
Adnexal masses

18
Q

Managment of endometriosis

A

pharmacological - COCP, GnRH analogues, progestogen implant, pill or inj, Mirena, aromatase inhibitors (less common)
surgical treatment - after 3-6m trial of ovarian supression

19
Q

Prefered surgical managment of endometriosis

A

Excision if severe.
Alternative is ablation.
Cystectomy for endometrioma rather than aspiration.
Final option - TAH + BSO

20
Q

What does uterine artery embolisation involve

A

Minimally invasive occlusion of the uterine artery is with polyvinyl alcohol beads.
Transfemoral approach
Local anaesthetic and light sedation

21
Q

Causes of menorrhagia

A 
40-60% no pathology
20% anovulatory cycle
Fibroids
Endometrial polyp
Endometriosis
Adenomyosis
Endometritis
PID
Endometrial hyperplasia
Endometrial carcinoma
Systemic disease-hypothyroidism, liver, kidney, obesity, von Willebrand disease
IUD
22
Q

Medical management of menorrhagia

A

Mirena -1st line

Tranexamic acid / Mefenamic acid / POP/COCP - 2nd line

23
Q

Types of eczema

A

Atopic - allergic
Allergic contact
Irritant contact

24
Q

Symptoms + signs of vulval eczema

A

Vulval Itch and soreness
Excoriation
Erythema, lichenification
Fissuring and pallor or hyperpigmentation

25
Q

Complications of vulval eczema

A

Secondary infection

26
Q

Management of vulval eczema

A 
Avoid precipitant
Emollient
Emollient soap substitute
Topical corticosteroid
Combined antifungal +/- antibiotic if required
27
Q

Symptoms of vulval psoriasis

A

Itch, soreness and burning

28
Q

Signs of vulval psoriasis

A

Well demarcated Erythematous plaques
Often lacks scaling
Frequent in natal cleft
Fissuring

29
Q

Management of vulval psoriasis

A 
Avoid irritating factors
Emollient
Topical corticosteroid
Week coal tar preparations
Vitamin D analogues
30
Q

Aetiology of VIN

A

May become cancerous if left untreated.
Can be HPV related - may resolve
May be lichen sclerosis or lichen planus related - higher risk of progression to SCC

31
Q

Symptoms of VIN

A

Lumps, erosions, burning, itch, irritation, pain

32
Q

Clinical appearance of V I N

A

Variable
Raised white, erythematous , pigmented
Lesions may be warty, moist, eroded
Multi focal lesions common

33
Q

Complications of VIN

A

Development of SCC
Recurrence
Psychosexual consequences

34
Q

Diagnosis of VIN

A

Biopsy

35
Q

Management of VIN

A 
colposcopy
Cervical cytology up-to-date
Local excision
Imiquimod cream
Vulvectomy
36
Q

Follow-up of VIN

A

Vulval clinic

Close follow-up

37
Q

Most common type of cervical cancer

A

80% squamous cell carcinoma

20% adenocarcinoma

38
Q

Presentation of triple x (47XXX)

A 
Female
1:1000
Neuromuscular delay
Developmental delay
Immature behaviour 
Reduced IQ
Tall
39
Q

Anovulation may be associated with what

8

A 
Drugs including some contraception
Stress / depression
Excess exercise
Excess weight loss
Chronic renal failure
Asthma
PCOS
Cushing syndrome
40
Q 
Normal ranges for:
Ostradiol 
LH
FSH
Prolactin 
Testosterone
A 
Normal ranges for:
Ostradiol 130 - 830 pmol/L
LH 1-10 mu/L
FSH 1 -10 
Prolactin 50 - 450 U/L
Testosterone <3 pmol/L
41
Q

Common causes of PMB

A 
Atrophy - 60%
Polyps - 12%
Endometrial cancer - 10%
Endometrial hyperplasia - 10%
Hormonal effect - 7%
Cervical cancer <1%

MFSRH (18 decks)

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