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Zero to finals Gynaecology > Differential Diagnosis in Gynaecology > Flashcards

Differential Diagnosis in Gynaecology Flashcards

1
Q

What are the most common presenting complaints in gynaecology?

A
  • Amenorrhoea
  • Irregular menstruation
  • Intermenstrual bleeding
  • Dysmenorrhoea
  • Menorrhagia
  • Postcoital Bleeding
  • Pelvic Pain
  • Vaginal discharge
  • Pruritis Vulvae
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2
Q

What is Amenorrhoea?
Primary vs secondary

A

*Primary–
Absence of menses by age 16 with normal secondary sexual characteristics–Absence of menses by age 14 without secondary sexual development

*Secondary–
Absence of menses for 6 months in a previously menstruating female- amenorrhoea refers to lack of menstrual periods

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3
Q

What is primary amenorrhoea?

A

Primary

–Absence of menses by age 16 with normal secondary sexual characteristics–Absence of menses by age 14 without secondary sexual developmen#

-primary amenorrhoea is when the patient has never developed periods

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4
Q

What is secondary amenorrhoea?

A

-secondary amenorrhoea is when the patient previously had periods that subsequently stopped

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5
Q

What are causes of primary amenorrhoea?

A
  • abnormal functioning of the hypothalamus/pituitary gland –> hypogonadotropic hypogonadism
  • abnormal functioning of gonads –> hyergonadotropic hypogonadism
  • imperforate hymen or other structural pathology
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6
Q

What are the causes of secondary amenorrhoea?

A
  • pregnancy (most common)
  • menopause
  • physiological stress due to exercise/low weight/chronic disease/psychosocial
  • polycystic ovarian syndrome
  • medications such as hormonal contraceptives
  • premature ovarian insufficiency (menopause before 40)
  • hyper/hypothyroidsm
  • prolactinoma
  • cushing’s syndrome
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7
Q

What does irregular menstruation refer to?

A
  • abnormal uterine bleeding –> irregularities in menstrual cycle affecting frequency, duration, cycle length and volume of menses.
  • irregular menstruation indicates anovulation (lack of ovulation) or irregular ovulation
  • it occurs due to disrupted menstrual hormone levels or ovarian pathology
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8
Q

What are the causes of irregular menstruation?

A
  • extremes of reproductive ages (early periods of perimenopause)
  • POS
  • physiological stress due to exercise/low weight/chronic disease/psychosocial
  • medications, especially progesterone only contraception, antidepressants and antipsychotics
  • hormonal imbalances such as thyroid abnormalities, cushings syndrome and high prolactin
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9
Q

What does intermenstrual bleeding refer to?

A
  • IMB refers to any bleeding that occurs between menstrual periods
  • is a red flag that makes you consider cervical and other cancers, though other causes more common
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10
Q

What are causes of intermenstrual bleeding?

A
  • hormonal contraception
  • cervical ectropion, polyps or cancer
  • STI
  • endometrial polyps or cancer
  • vaginal pathology, including cancers
  • pregnancy
  • ovulation can cause spotting in some women
  • medication such as SSRIs and anticoags
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11
Q

What does dysmenorrhoea refer to?

A

-dysmenorrhoea describes painful periods

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12
Q

What are causes of dysmenorrhoea?

A

-primary dysmenorrhoea (no underlying pathology)
-endometriosis or adenomyosis
-fibroids
-pelvic inflammatory disease
-copper coil
cervical or ovarian cancer

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13
Q

What does menorrhagia refer to?

A

-menorrhagia refers to heavy menstrual bleeding

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14
Q

What can cause menorrhagia?

A
  • Dysfunctional uterine bleeding (no identifiable cause)
  • fibroids
  • endometriosis and adenomyosis
  • PID (infection)
  • Contraceptives –> especially copper coil
  • anticoags
  • bleeding disorders eg VWD
  • endocrine disorders (diabetes/hypothyroidsm)
  • connective tissue disorders
  • endometrial hyperplasia or cance
  • polycystic ovarian syndrome
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15
Q

What does postcoital bleeding refer to?

A
  • PCB refers to bleeding after sexual intercourse
  • is a red flag so consider cervical and other cancers
  • often no cause is found
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16
Q

What are causes of postcoital bleeding?

A
  • cervical cancer, ectropion or infection
  • trauma
  • atrophic vaginitis
  • polyps
  • endometrial cancer
  • vaginal cancer
17
Q

What is the presentation of pelvic pain?

A
  • can be chronic or acute
  • presentation varies significantly
  • detailed history and examination needed to identify cause as a large number of causes
18
Q

What are causes of pelvic pain?

A
  • UTI
  • dysmenorrhoea
  • IBS
  • ovarian cysts
  • endometriosis
  • PID (infection)
  • ectopic pregnancy
  • appendicitis
  • pelvic adhesions
  • mittelschmerz (cyclical pain during ovulation)
  • ovarian torsion
  • IBD
19
Q

What is the presentation of vaginal discharge?

A
  • vaginal discharge is normal finding

- it is only abnormal if it is excessive, discoloured or foul-smelling

20
Q

What might abnormal vaginal discharge indicate?

A
  • bacterial vaginosis
  • candidiasis(thrush)
  • chlamydia
  • gonorrhoea
  • trichomonas vaginalis
  • foreign body
  • cervical ectropion
  • polyps
  • malignancy
  • pregnancy
  • ovulation
  • hormonal contraception
21
Q

What does pruritus vulvae refer to?

A

-pruritus vulvae refers to itching of the vulva and vagina

22
Q

What are the causes of pruritus vulvae?

A
  • Irritants such as soaps,detergents and barrier contraception
  • atrophic vaginitis
  • infecttions such as candidiasis and pubic lice
  • skin conditions such as eczema
  • vulval malignancy
  • pregnancy related vaginal discharge
  • stress
23
Q

A 24 year old female presents to the gynaecology rapid access clinic complaining of extreme pain ‘down below’

On examination, there is a hard 2cm lump at the posterolateral aspect of the introitus with surrounding erythema and swelling. It is exquisitely tender and there is associated inguinal lymphadenopathy.

What is the most likely diagnosis?

A. Bartholin’s gland carcinoma

B. Cystocoele

C. Bartholin’s gland cyst

D. Bartholin’s gland abscess

E. Skene’s duct cyst

A

D. Bartholin’s gland abscess

Bartholin’s glands are part of the normal anatomy, however are usually not palpable. They function to secrete a lubricating fluid and open just inside the vagina. They can become blocked and swollen, forming a Bartholin’s gland cyst, which becomes palpable. If this cyst becomes infected, as in this case, it forms an abscess.

Bartholin’s gland abscesses are usually treated with incision and drainage, with insertion of a word catheter to encourage marsupialisation. Oral antibiotics are usually sufficient to treat the infection if the patient is otherwise systemically well

not B. cystocoele: A cystocele is caused by a defect in the anterior vaginal wall, allowing the bladder to prolapse into the vaginal vault. This case is not clinically a cystocele

not C: Bartholin’s gland cyst: A Bartholin’s gland cyst is a swollen gland, but is not typically painful and does not present with surrounding erythema or lymphadenopathy

Not E: Skene’s duct cyst

The Skene’s glands are situated just lateral to the urethra and can become blocked and cystic, however anatomically, this case is far more likely to be a Bartholin’s gland pathology

24
Q

EPU (early pregnancy unit) up to what gestation?

A

The Early Pregnancy Unit is a consultant-led service and is delivered by a team of specialist nurse sonographers who provide consultation, assessment, scans and treatment plans for women with complications of pregnancy from 5 to 20 weeks.

Zero to finals Gynaecology (24 decks)

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