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Obs & Gynae (Gynae) > Benign Gynaecological Tumours & Prolapse > Flashcards

Benign Gynaecological Tumours & Prolapse Flashcards

1
Q

What are the main risk factors for the development of a prolapse?

A

Childbirth, ageing and family history

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2
Q

What structures may be damaged in pregnancy and childbirth, which contribute to the development of a prolapse?

A

Levator ani muscle and pudendal nerve

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3
Q

Why does post-menopausal oestrogen deficiency lead to an increased risk of prolapse?

A

Atrophy of pelvic support

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4
Q

What is the main symptom of a prolapse?

A

Dragging sensation or a lump coming down

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5
Q

What happens to the symptoms of a prolapse as the day progresses?

A

They get worse

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6
Q

Why may prolapses result in bleeding/discharge?

A

Ulceration from friction

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7
Q

What are some features specific to a cystocele?

A

Incomplete emptying, frequency/hesitancy, recurrent UTIs

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8
Q

What are some features specific to a rectocele?

A

Constipation, digitation, faecal incontinence

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9
Q

What should always be examined first in a patient with a suspected prolapse and why?

A

The abdomen, to check for masses

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10
Q

How is a prolapse diagnosed?

A

On clinical examination, as the patient coughs

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11
Q

What are some conservative management options for a prolapse?

A

Weight loss, smoking cessation, pelvic floor exercises, pessaries

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12
Q

What is the most commonly used type of pessary?

A

Ring

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13
Q

Can you have sex with a ring pessary in?

A

Yes

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14
Q

How often should pessaries be changed?

A

Every 6 months

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15
Q

What is the biggest problem if a woman forgets that she has a pessary in?

A

Erosion

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16
Q

What medical treatment may be useful for post-menopausal women with a prolapse?

A

Low dose oestrogen pessaries or creams

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17
Q

Surgical treatment should not be offered for a prolapse unless the prolapse is below what level?

A

The introitus

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18
Q

Anterior colporrhaphy is used for which type of prolapse?

A

Cystocele

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19
Q

What are some surgical management options that could be used for a uterine prolapse?

A

Hysterectomy or sacrohysteropexy

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20
Q

Posterior colporrhaphy is used for which type of prolapse?

A

Rectocele

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21
Q

What surgical management option is available for a vaginal prolapse?

A

Sacrospinous fixation

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22
Q

What are uterine fibroids?

A

Benign leiomyomas (benign smooth muscle tumours)

23
Q

Within which layer of the uterine wall do fibroids develop?

A

Myometrium

24
Q

It is unclear what causes fibroids to start growing, but once they have grown they are responsive to what?

A

Oestrogen and progesterone

25
Q

Fibroids are known for growing significantly when? And shrinking significantly when?

A

Growing in pregnancy and shrinking after the menopause

26
Q

Fibroid degeneration is a common cause of abdominal pain when?

A

In mid-pregnancy

27
Q

How does fibroid degeneration typically present?

A

Low grade fever, pain and vomiting

28
Q

How is fibroid degeneration managed?

A

Rest and analgesia (it will resolve spontaneously in 4-7 days)

29
Q

Rapid growth of a uterine mass is concerning, particularly in post-menopausal women, because it raises suspicion of what?

A

Uterine sarcoma

30
Q

What effect do fibroids have on the menstrual cycle?

A

Menorrhagia

31
Q

What is the imaging investigation of choice for uterine fibroids?

A

Trans-vaginal ultrasound

32
Q

What medical treatment can be offered to women with symptomatic fibroids?

A

COCP, POP, Mirena-IUS

33
Q

What medication can be given for 6 months to shrink fibroids before surgical resection?

A

GnRH analogues

34
Q

What interventional radiological procedure is a treatment option for for fibroids?

A

Uterine artery embolisation

35
Q

What is the first line surgical treatment for fibroids in women who want to preserve their fertility?

A

Myomectomy (hysteroscopically or laparoscopically)

36
Q

What is the first line surgical treatment for fibroids in women who do not want children or who have completed their families?

A

Hysterectomy

37
Q

What are the two types of physiological ovarian cysts?

A

Follicular and corpus luteum cysts

38
Q

Which type of ovarian cyst is this describing: common, small, fluid-filled cysts which are generally asymptomatic and resolve spontaneously?

A

Physiological cysts

39
Q

Which type of ovarian cyst is this describing: common cyst filled with altered blood at different stages of clot formation and breakdown, may present with pelvic pain?

A

Endometrioma

40
Q

What is the origin of an ovarian teratoma?

A

Germ cell tumour

41
Q

Which type of ovarian cyst is this describing: very common with a thick capsule, may contain fat, hair, teeth, bone etc and can be very large- 10% are bilateral?

A

Mature teratoma

42
Q

Which type of ovarian cyst is this describing: common, may grow very large, can be complex and multi-locular and filled with thin, clear or thick, mucoid fluid?

A

Cystadenoma

43
Q

What are the three features of the RMI tool used to differentiate between benign and malignant ovarian masses?

A

Menopausal status, CA125 and ultrasound appearance

44
Q

How should simple ovarian cysts < 5cm be managed?

A

Serial ultrasound scans

45
Q

How are symptomatic ovarian cysts or those > 5cm diameter managed?

A

Surgical excision

46
Q

When should endometriomas > 6cm diameter be removed?

A

If the woman is undergoing asssisted conception treatment

47
Q

What are some risk factors for ovarian torsion?

A

Ovarian mass, reproductive age, pregnancy

48
Q

Patients presenting with sudden onset, deep-seated, colicky abdominal pain associated with vomiting and distress should raise suspicion of what diagnosis?

A

Ovarian torsion

49
Q

A whirlpool pattern on ultrasound is suggestive of what diagnosis?

A

Ovarian torsion

50
Q

What procedure is both diagnostic and therapeutic for an ovarian torsion?

A

Laparoscopy

51
Q

Rokitansky’s protruberance is associated with which benign ovarian cyst?

A

Dermoid cyst

52
Q

Which type of benign ovarian cyst will cause pseudomyxoma peritonei if it ruptures?

A

Mucinous cystadenoma

53
Q

What type of ovarian cyst is most commonly associated with Meig’s syndrome?

A

Fibroma

54
Q

What is the most common benign ovarian tumour in those aged < 25?

A

Dermoid cyst

Obs & Gynae (Gynae) (5 decks)

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