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GYN > Common presentations > Flashcards

Common presentations Flashcards

1
Q

Differentials for abnormal uterine bleeding?

A
  • heavy menstrual bleeding vs intermenstrual bleeding

STRUCTURAL CAUSES (PALM)

  • polyp
  • adenomyosis
  • leiomyoma
    • submucosal/other
  • malignancy and hyperplasia

NON-STRUCTURAL (COEIN)

  • Coagulopathy
  • Ovulatory dysfunction
  • Endometrial
  • Iatrogenic
  • Not yet classified?

Classified as:

  • regular: cycle-cycle variability of <20days
  • irregular: cycle-cycle variability of >20days
  • heavy - >8days of bleeding per cycle
  • postmenopausal: any bleed >1 year after menopause - MUST RULE OUT ENDOMETRIAL CANCER

** post menopausal bleeding is endometiral cancer until proven otherwise

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2
Q

Differentials for dysmenorrhoea?

A

= painful menstruation, typically involving abdominal cramps

  • Primary/idiopathic
  • Secondary (acquired)
    • endometriosis
    • adenomyosis
    • uterine polyps
    • uterine anomalies
    • leiomyoma
    • intrauterine synechiae
    • ovarian cysts
    • cervical stenosis
    • imperforate hymen, transverse vaginal spetum
    • pelvic inflammatory disease
    • IUD (copper)
    • foreign body
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3
Q

Differentials for vulval pruritis?

A
  • physiologic discharge/cervical mucus production
  • non-physiological
    • genital tract infection
    • vulvovaginitis: candidiasis, trichomoniasis, BV, polymicrobial superficial infection
    • chlamydia, gonnorea
    • pyosalpinx, salpingitis
    • genital tract inflammation
    • local - chemical irritants, douches, sprays, foreign body, trauma, atrophic vaginitis
    • neoplasia: vulvar, vaginal, cervical, endometrial
    • systemic: toxic shock syndrome, Crohn’s disease, collagen disease, dermatologic (lichen sclerosis)
    • IUD, OCP (secondary to progesterone)
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4
Q

Differentials for pelvic pain?

A

ACUTE

  • GYN
    • ruptured ectopic
    • haemorrhage into cyst
    • ovarian torsion
    • fibroid degeneration
    • torsion of pedunculated fibroid
    • pyometra (infection of the uterus)
    • PID
    • endometriosis
  • NON-GYN
    • appendicitis
    • mesenteric adenitis
    • diverticulitis
    • IBD
    • UTI
    • renal colic
  • PREGNANCY RELATED
    • labour
    • ectopic
    • spontaneous abortion
    • placental abruption

CHRONIC

  • GYN
    • chronic PID
    • endometriosis
    • adenomyosis
    • adhesions
    • dysmenorrhoea
    • ovarian cyst
    • fibroid (Rare)
    • uterine prolapse (rare)
  • NON-GYN
    • referred pain
    • urinary retention
    • urethral syndrome
    • interstitial cystitis
    • GI neoplasm
    • IBS
    • IBD
    • constipation
    • partial bowel obstruction
    • diverticulitis
    • hernia
    • sexual abuse
    • depression/anxiety/somatization
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5
Q

Ovarian causes of pelvic mass?

A
  • corpus luteum cyst
  • follicular cyst
  • theca lutein cyst
  • hemorrhagic cyst

Neoplasm

  • dermoid cyst - benign, most common
  • epithelial cell
  • germ cell

OTHER

  • PCOS
  • endometrioma
  • tubo-ovarian abscess
  • luteoma of pregnancy
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6
Q

Tubal causes of pelvic mass?

A
  • ectopic pregnancy
  • malignancy
  • tubo-ovarian abscess (PID)
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7
Q

Uterine causes of pelvic mass?

A
  • pregnancy
  • adenomyosis
  • pyometra/hematometra
  • endometrial cancer
  • imperforate hymen
  • leiomyoma
  • leiomyosarcoma
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8
Q

Non-gyn causes of pelvic mass?

A
  • diverticulosis/diverticulitis
  • cancer of rectum/colon
  • distended bladder
  • bladder cancer
  • pelvic kidney
  • lymphoma
  • diverticular abscess, appendiceal abscess
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9
Q

Causes of dyspareunia?

A

first ask WHERE is the pain - introital, mid vaginal, deep

INTROITAL

  • inadequate lubrication
  • vaginismus
  • rigid/intact hymen
  • bartholin’s or skene’s gland infection
  • lichen sclerosis
  • vulvovaginitis: atrophic , chemical, infectious (chlamydia, trichomoniasis)

MIDVAGINAL

  • urethritis
  • short vagina
  • trigonitis
  • congenital abnormality of the vagina

DEEP

  • endometriosis
  • adenomyosis
  • leiomyomata/fibroids
  • PID
  • hydrosalpinx
  • tubo-ovarian abscess
  • uterine retroversion
  • ovarian cyst
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10
Q

Important history questions for 1st and 2nd trimester bleeding?

A
  • risk factors for ectopic
  • previous spontaneous abortion
  • recent trauma
  • characteristics of bleeding
  • characteristics of pain
  • history of coagulopathy
  • gyn/obstetric history
  • fatigue, dizziness, syncopal episodes due to hypovolaemia, fever (septic abortion?)
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11
Q

Important aspects of physical exam for first/second trimester bleeding?

A
  • vitals
  • abdomen - fundal height, tenderness, presence of contractions
  • perineum - signs of trauma/genital lesions
  • speculum exam - cervical os open or closed, presence of active bleeding/clots/tissue
  • pelvic exam - uterine size, adnexal mass, uterine/adnexal tenderness
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12
Q

Investigations for first/second trimester bleeding?

A
  • BhCG
  • USS
  • FBC
  • group + screen
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GYN (2 decks)

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