Acute Gynae Flashcards

1
Q

What are investigations for unilateral abdo pain in female with suspicion of ectopic?

A

FBC, G&S, USS - FAST scan versus transvaginal

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2
Q

What is presentation of ectopic pregnancy? (8)

A

shoulder tip pain, bleeding, LMP, dyschezia, vomiting and diarrhoea, faint, hypotensive, tachycardia

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3
Q

Ectopic pregnancy risk factors (7)

A

previous ectopic, tubal damage, IUS/IUD, smoking, infertility, infertility treatment, odler reproductive age

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4
Q

Initial management of ectopic

A

resus, ABCDE

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5
Q

What are surgical managements options for ectopic

A

laparoscopic, laparotomy, salphingectomy, salphingotomy, anti D if necessary

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6
Q

Pregnancy of unknown location presentation in terms of HCG levels?

A

static HCG - if goes down then failing, if static then unknown location, if rising then normal pregnancy. , clinically well

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7
Q

What are management options for PUL?

A

expectant management, medical: methotrexate, consider surgical

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8
Q

Cyst presentation (4)

A

sudden onset unilateral fossa pain,
faint,
tachycardia,
normotensive

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9
Q

Cyst investigations? (3)

A

Bloods (FBC, CRP, G&S), palpable mass on vaginal exam, transvaginal ultrasound

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10
Q

Torsion is more likely with a cyst of what size?

A

more likely with a cyst >5cm

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11
Q

What percent of ovarian torsion are caused by dermoid cysts?

A

10%

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12
Q

What percent of adnexal torsions occur in children?

A

25%

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13
Q

Premenopausal ovarian torsion most likely ____ whereas postmenopausal ovarian torsion most likely ___

A

benign, malignant (shouldn’t be producing follicles)

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14
Q

Ovarian torsion treatment (5)

A
resus and ABCDE, 
laparoscopy/laparotomy, 
detorsion, 
cystectomy, 
oophrectomy (if necrotic)
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15
Q

Cyst accident presentation? (6)

A
sudden onset unilateral fossa pain, 
may be precipitated by sex, sports or spontaneous, 
tachycardic, 
hypotensive, 
apyrexial,
 HCG negative
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16
Q

Cyst accident investigations?

A

Bloods (FBC, CRP, G&S), peritonism, ultrasound

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17
Q

How does fluid in peritoneum appear on USS in cyst rupture in comparison to ectopic rupture?

A

Cyst rupture all black, watery fluids as opposed to different colours in ectopic pregnancy ruputre

18
Q

Cyst rupture commonly occurs in what type of cyst and rarely in which?

A

common in functional cysts, rarely in dermoid or endometrioma

19
Q

Management cyst accident?

A

Conservative if not that unwell. If unwell resus, laparoscopy, lavage, stop bleeding, oophrectomy if needed

20
Q

Presentation PID? (7)

A
gradual onset generalised lower abdo pain, 
discharge, 
dyspareunia, 
intermenstrual & post coital bleeding, 
anorexia, 
n&v (but more likely with appendicitis) 
normal HR, BP, temp and HCG neg
21
Q

PID investigations

A

Bloods: FBC, CRP, LFT (PIDs can irritate liver), Cervical motion tenderness, genital swabs x2

22
Q

What is another word for cervical excitation?

A

cervical motion tenderness

23
Q

What is PID and what can it cause inflammation of?

A

An ascending infection from endocervix that can cause endometritis, salphingtitis and tubo-ovarian abscess

24
Q

List 4 organisms that can cause PID

A

Chlamydia, gonorrhoea, gardenella, anaerobes

25
Q

What are some long term complications of PID? (3)

A

Infertility, chronic pelvic pain and ectopic pregnancy

26
Q

Management of PID?

A

14 days metronidazole and doxycycline, IV if needed, remove IUD if can, laparoscopy if needed to drain abscess

27
Q

What are 4 menstrual causes of acute bleeding?

A

If you get anovulatory periods e.g. puberty or premenopause, fibroids, on anticoagulant, von willebrand’s disease

28
Q

What are 4 non menstrual causes of acute bleeding?

A

miscarriage, cervical causes, endometrial cancer, vaginal trauma

29
Q

Why do fibroids cause acute bleeding?

A

Fibroids increase surface area of uterus so more area to bleed from

30
Q

Acute vaginal bleeding investigations?

A

Bloods (FBC, CRP, Coag, G&S, HCG, LFTs, Ferritin), consider: endometrial biopsy (in 40s,50s), cervical biopsy, examine pad, ultrasound ( for thickened endometrium, fibroids)

31
Q

What are management options for acute bleeding?

A

resus, tranexamic acid (antifibrinolytic to prevent clot breakdown), mefanamic acid (NSAID to reduce blood supply), norethisterone (synthetic progesterone, stabilises endometrium), IUS (stabilises endometrium), COC, GnRH analogues (overload system so downregulation of FSH and LH)

32
Q

HSV Presentation?

A

vulval pain, ulceration, discharge, dyrsuria, urinary retention

33
Q

Investigations HSV?

A

Viral swab

34
Q

Treatment HSV?

A

aciclovir, consider bladder catheter if urinary retention, local anaesthetic gel

35
Q

Bartholin’s glands are at 5 and 7 o clock. Bartholins gland cyst presentation?

A

Infection signs, swelling, pain, waddle into clinic and sit on one buttcheek

36
Q

Bartholins abscess investigations?

A

swab

37
Q

Bartholins cyst treatment?

A

Conservative if not infected (will drain itself), antibiotics - broad spectrum, incision and drainage, word catheter, marsupialisation

38
Q

4 other considerations of acute gynae presentation causes?

A

retained tampon, foreign body in vagina, procidentia (prolapse), post colposcopy infection

39
Q

Negative swabs exclude PID. True/false?

A

False - they don’t exclude

40
Q

What is another name for fibroid?

A

Leiomyoma

41
Q

How can anovulation cause acute bleeding?

A

Get a build up of a couple months of period coming out at once