Common gynaecological conditions

Question 1

What is PID and what exam+investigation findings are required for clinical diagnosis?

Answer 1

Ascending infection. Typically STI. Inflammation within pelvic girdle i.e endometritis, salpingitis, oophritis, peritonitis.

1) Abdo pain
2) Adenexal tenderness
3) Cervical motion tenderness

& 1 or more of: elevated CRP, ESR, Leukocytosis, fever or purulent cervical d/c

Question 2

What are the most common organisms to cause PID? and thus what are the treatments?

Answer 2

Neisseria gonorrhorea and chlamydia trachomatis.

Follow local abx guidelines but its multiple covers i.e Ceftriaxone + doxycycline

Question 3

What is endometriosis? What are the signs and symptoms?

Answer 3

• Endometriosis is the presence of endometrial gland tissue outside of the endometrium

Signs and symptoms:
- Dysmennorhoea (pain)
- Dyspareunia (pain sex)
- Dyschezia (Pain poop)

Commonly on ovaries = adenexal tenderness

Question 3

How is candida treated?

Answer 3

Topical or oral antifungals

Question 3

What can PID progress to?

Answer 3

Repetative scarring can lead to tuboovarian abscess.. This can rupture. -> Laparotomy

Question 3

How is a diagnosis of endometriosis made?

Answer 3

Laproscopic visualisation is the gold standard.

Second most common cause of infertility following PID

Question 4

How is trichomonas vaginalis treated?

Answer 4

Metronidazole

Question 5

How is herpes treated?

Answer 5

Acyclovir or valacyclovir

Question 6

How is syphillis stage 1 and 2 treated?

Answer 6

Penicillin

Question 7

How is chlamydia treated?

Answer 7

Most common STI

• Doxycycline
• Azithromycin (if pregnant)

Question 8

How is neisseria gonorrhoea treated?

Answer 8

Ceftriaxone

Question 9

Whats typically the best course of action for someone with gonorrhoea?

Answer 9

Ceftriaxone and doxycycline for presumed co-infection of chlamydia.

Not true for the reverse

Question 10

What is adenomyosis? Whats the common exam findings?

Answer 10

Endometrial glands in the uterine musculature.

Large boggy uterus with hx of dysmenorrhorea or menorraghia

Question 11

How is adenomyosis treated?

Answer 11

Dilatation and curetage to rule out endometrial cancer.

Hysterectomy for symptom relief.

Question 12

What are uterine fibroids? What are they dependent on and what is curative?

Answer 12

Fibroids i.e leiomyomas are benign uterine tumors. ESTROGEN DEPENDENT

If grow too large or cause symptoms (menorrhagia -> bleeding) then hysterectomy is curative

1% malignant transformation.

Question 13

What can cause dysfunctional uterine bleeding other than PCOS?

Answer 13

DUB - Bleeding not associated with tumor, inflammation or pregnancy.

Commonly caused by unopposed estrogen.
-> PCOS
-> Thyroid
-> Adrenal
-> Pituitary / prolactin
-> Coag issues
-> Estrogen producing neoplasms

Always check for uterine cancer if >35

Question 14

Define PCOS:

Answer 14

Characterised androgen excess with LH:FSH ratio of 2:1

• Polycystic ovaries (US)
• Hirsutism
• Amenorrhoea
• Acne
• Overweight

Question 15

How is PCOS treated?

Answer 15

• COCP
• Metformin

Question 16

Distinguish primary and secondary amenorrhoea:

Answer 16

Primary: Never mensturated
Secondary: Has stopped

Question 17

What is primary dysmenorrhoea?

Answer 17

Painful periods in the absence of pathology

Commonly treated with NSAIDS, warm packs etc

Question 18

What is secondary dysmenorrhoea?

Answer 18

Painful mensturation caused by organic cause i.e PID, Ectopic pregnancy

Question 19

What is the acronym for abnormal uterine bleeding?

Answer 19

Structural:
P - Polyp
A - Adenomyosis
L - Leiomyoma (Fibroid)
M - Malignancy / endometrial hyperplasia
Non-Structural:
C - Coagulopathy
O - Ovulatory dysfunction
E - Endometrial
I - Iatrogenic
N - Not yet classified

Question 20

What are the investigations utilised in the work up for abnormal uterine bleeding?

Answer 20

• Cervical smear
• Swabs - STI
• FBC (anaemia)
• Coags
• TFT
• Prolactin
• Imaging

Question 21

When a woman presents with nipple discharge what are important aspects of the hx to attain?

Answer 21

• OCP use
• Hormone therapies
• Antipsychotic medications
• Hypothyroidism symptoms.
• Colour of d/c
• Uni or bilateral

Question 22

What is the most common cause of a breast mass in a woman <35 years of age?

Answer 22

• Fibrocystic disease
• Fibroadenoma
• Mastitis / abscess
• Fat necrosis

Question 23

How is mastitis managed?

Answer 23

• Continue breast feeding always to prevent duct blockage and abscess formation.
• Analgesic + Anti-staph i.e cephalexin
• if MRSA: Clindamycin or trimethoprim
• If fluctuant mass and no improving it will be an abscess that needs draining.

Question 24

What is the usual cause of vaginal bleeding in the neonate?

Answer 24

• Vaginal bleeding in neonates is usually physiological and as a result of maternal estrogen withdraw. Self resolving.

Question 25

What are absolute contraindications to hormone replacement therapy?

Answer 25

• Unexplained vaginal bleeding
• Acute liver disease
• History of thromboembolism
• CAD
• Hx of endometrial or breast cancer
• Pregnancy

Question 26

What are the relative contraindications to hormone replacement therapy?

Answer 26

• Seizure disorder
• HTN
• Uterine leiomyomas
• Familial hyperlipidaemia
• Migraine headaches
• Thrombophlebitis
• Endometriosis
• Gallbladder disease

Question 27

What are the absolute contraindications to the COCP?

Answer 27

• VTE, DVT, or PE
• Stroke
• CAD
• Valvular disease
• Db with complications
• Breast cancer
• Pregnancy
• Lactation
• Liver disease
• Headaches with focal neurology
• Smoking 15+ and are 35+
• HTN with vascular disease

Question 28

Whats the relationship with the COCP and BP?

Answer 28

OCP is the most common cause of secondary HTN

Question 29

How does the oral contraceptive pill relate to surgery?

Answer 29

Pill should be stopped 1 month before surgery and no restarted until one month after