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Reproduction > Acute gynaecology and vulval conditions > Flashcards

Acute gynaecology and vulval conditions Flashcards

1
Q

What is an ectopic pregnancy?

A

A pregnancy outwith the endometrial cavity

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2
Q

Name symptoms of ectopic pregnancy

A
  • shoulder tip pain
  • bleeding
  • LMP
  • dyschezia
  • vomiting and diarrhoea
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3
Q

Name risk factors for ectopic pregnancy

A
  • previous ectopic
  • tubal damage; infection, endometriosis, surgery
  • intrauterine contraceptive devices
  • smoking
  • infertility
  • infertility treatment
  • extremes of reproductive age
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4
Q

Describe the management of ectopic pregnancy

A
  • resuscitation
  • ABCDE
  • laparoscopy
  • laparotomy
  • salphingectomy or salphingotomy
  • anti D
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5
Q

What are the clinical signs of pregnancy of unknown location and what is the management?

A
  • static HCG (HCG should double every 24 hours
  • clinically well
  • expectant management
  • medical management; methotrexate
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6
Q

Describe the management of ovarian torsion?

A
  • resuscitation
  • laparoscopy
  • laparotomy
  • detorsion
  • cystectomy
  • oophorectomy
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7
Q

Describe the management of cyst rupture

A
  • conservative
  • resuscitation
  • laparoscopy
  • lavage
  • stop bleeding
  • ?oophorectomy
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8
Q

Name causes of pelvic inflammatory disease

A
  • ascending infection from endocervix
  • endometritis, salphingitis, tubo-ovarian abscess
  • chlamydia
  • gonorrhoea
  • gardenella
  • anaerobes
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9
Q

Describe management of acute bleeding?

A
  • resuscitation
  • tranexamic acid
  • mefenamic acid
  • norethisterone
  • IUS
  • COCP
  • GnRH analogues
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10
Q

Name symptoms of HSV infection

A
  • pain
  • ulceration
  • discharge
  • dysuria
  • urinary retention
  • inguinal lymphadenopathy
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11
Q

Describe management of HSV infection

A
  • aciclovir
  • bladder catheter
  • local anaesthetic gel
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12
Q

Describe management of bartholins abscess

A
  • conservative
  • antibiotics; broad spectrum
  • incision and drainage
  • word catheter
  • marsupialisation
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13
Q

Name differentials of vulval itch

A
  • candidiasis; albicans, non-albicans
  • trichomoniasis
  • pubic lice
  • scabies
  • vulval intra-epithelial neoplasia
  • atrophic vulvovaginitis
  • dermatitis; atopic, irritant, allergic
  • psoriasis
  • lichen sclerosis
  • lichen planus
  • lichen simplex chronicus
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14
Q

What is lichen sclerosus?

A

Inflammatory, scarring dermatosis of ano-genital skin

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15
Q

What can typically be seen on examination in lichen sclerosus?

A
  • white papules and plaques (vulval and perineal skin, figure of 8 pattern, vagina not involved)
  • ecchymosis, erosions and fissures
  • architectural change
  • extragenital skin involvement (10% of women with vulval disease)
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16
Q

Describe the management of lichen sclerosus

A
  • genital skin care; wash gently once a day with soap substitute, avoid irritants, try to avoid tight clothing rubbing scratching etc, apply emollients to relieve dryness and itching
  • potent topical steroid (clobetasol propionate 0.05% AKA dermovate); 1/2 finger tip unit, 12 week regimen then PRN
17
Q

Name differentials of vulval pain

A 
Acute; 
- genital ulceration; primary herpes, recurrent herpes, apthous ulcers, varicella zoster 
- traumatic 
- bartholins cyst / abscess 
- dermatitis 
Chronic 
- vulvudynia; generalised /localised, provoked / unprovoked 
- female genital mutilation 
- pudendal nerve dysfunction 
- lichen sclerosis 
- lichen planus 
- vulval intra-epithelial neoplasia / cancer
18
Q

What can be seen on examination for vulvodynia?

A
  • high tone at introitus
  • v tender on advancing small speculum; unable to tolerate
  • mucosae unremarkable
  • point tenderness 4-7 o clock with cotton swab
19
Q

What is vulvodynia?

A
  • vulval discomfort, most often described as burning pain, occuring in the absence of relevant visible findings or a specific, clinically identifiable, neurological disorder
  • generalised or localised
  • provoked, unprovoked or mixed
20
Q

Describe the management of vulvodynia

A
  • information
  • genital skin care advice and emollients
  • localised provoked pain; lidocaine 5% ointment, vaginal trainers, physiotherapy
  • unprovoked pain; tricyclics, gabapentin / pregabalin
  • psychosexual interventions
21
Q

What is the WHO classification of FGM?

A
  • type 1; partial or total removal of the clitoris and or the prepuce (clitoridectomy)
  • type 2; partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision)
  • type 3; narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and or the labia majora, with or without excision of the clitoris (infibulation)
  • type 4; all other harmful procedures to the female genitalia for non-medical purposes for example; pricking, piercing, incising, scraping and cauterisation
22
Q

What are the short term complications of FGM?

A
  • haemorrhage
  • urinary retention
  • genital swelling
  • infection and sepsis
23
Q

What are the long term complications of FGM?

A
  • urinary tract infections; type 2 and type 3
  • urinary stricture or fistulae
  • dyspareunia, apareunia and impaired sexual function
  • PTSD
  • haematocolpos
  • HIV and hep B
  • obstetric complications; obstructed labour, postpartum haemorrhage, perineal trauma and sphincter injury
24
Q

What is the most common form of vulval cancer?

A

Squamous cell carcinoma

25
Q

Name risk factors for prolpase

A
  • women
  • pregnancy, childbirth, menopause
  • increasing age
  • obesity
  • smoking
  • heavy lifting
  • constipation
  • COPD
  • prior pelvic surgery
26
Q

Name signs and symptoms of prolapse

A
  • sensation of heaviness or pulling in your pelvis
  • tissue protruding from your vagina
  • urinary problems, such as urine leakage (incontinence) or urine retention
  • trouble having a bowel movement
  • feeling as if you’re sitting on a small ball or as if something is falling out of your vagina
  • sexual concerns
27
Q

Describe the degrees of uterine descent of uterovaginal prolapse

A
  • 1st degree; in vagina
  • 2nd degree; at interoitus
  • 3rd degree; outside vagina
  • 4th degree; entirely outside vagina
28
Q

Describe symptoms of cystocele (anterior)

A
  • bulging
  • pressure
  • mass
  • difficulty voiding
  • incomplete emptying
  • splinting vaginal wall
  • difficulty inserting tampon
  • pain with intercourse
29
Q

Describe symptoms of rectocele (posterior)

A
  • bulging
  • pressure
  • mass
  • difficulty in defecation
  • incomplete defecation
  • splinting vaginal wall or perineum
  • difficulty inserting tampon
30
Q

Describe the pelvic organ prolapse quantification system (POP-Q)

A
  • patient straining 6 specific sites are evaluated and 3 at rest
  • measure each site (cm) in relation to the hymenal ring, which is fixed
  • the hymenal ring is the zero point of reference
  • if a site is above the hymen, assigned a negative number
  • if site prolapses below the hymen, the measurement is positive

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