General gynae Flashcards
menorrhagia, fibroids, endometriosis, adenomyosis, ovarian cysts, urogynae, pelvic congestion
1
Q
Define menorrhagia
A
heavy bleeding in otherwise normal cycle (impairing QoL or >80ml)
2
Q
What proportion of women have menorrhagia
A
one third
3
Q
What are the investigations for menorrhagia for under 45s
A
FBC, transvaginal US
4
Q
What are the investigations for menorrhagia for >45s
A
FBC, transvaginal US, endometrial biopsy
5
Q
3 options for medical treatment of menorrhagia
A
- Mirena / COCP
- antifibrinolytics + NSAIDs
- progestogens (oral/IM)
6
Q
name an antifibrinolytic for menorrhagia
A
tranexamic acid
7
Q
name an NSAID for menorrhagia
A
mefenamic acid
8
Q
name a progestogen for menorrhagia
A
norethisterone
9
Q
give me two surgical options for menorrhagia
A
endometrial ablation
hysterectomy
10
Q
what is the posh name for fibroids
A
leiomyoma
11
Q
what actually are fibroids?
A
benign myometrium tumours
12
Q
what proportion of women under 30 have fibroids
A
one third
13
Q
give me 4 sites for fibroids
A
intracavity
submucosal
intramural
subserosal
14
Q
FHx, nulliparous, near menopause, afro-Caribbean are all risk factors for …
A
fibroids
15
Q
Half of fibroids are asymptomatic. True or false?
A
true!
16
Q
what two key symptoms do fibroids cause
A
menorrhagia
dysmenorrhoea
17
Q
why can fibroids cause frequency and infertility
A
press on bladder
prevent implantation
18
Q
Fibroids are oestrogen dependent. This means they can be treated with prog only pill and Mirena. Give me two other medical options for fibroids
A
GnRH analogues
Ulipristal acetate
19
Q
Give me the main surgical option for fibroids
A
MYOMECTOMY
if small - hysteroscopic resection
if completed fam - hysterectomy
20
Q
Haemorrhage and torsion are two complications of fibroids. Name two others;
A
red degeneration in pregnancy
leiomyosarcoma
21
Q
what happens to size of fibroids in pregnancy
A
they might grow, shrink or stay the same!
22
Q
why do fibroids regress in menopause
A
oestrogen dependent
23
Q
define endometriosis
A
growth of endometrium tissue outside uterus!
24
Q
where can endometriosis spread to
A
OVARIES
UTEROSACRAL LIGAMENTS
abdo scars, rectum, bladder
(can even spread in lymph to lungs)
25
give me the THREE KEY symptoms of endometriosis
cyclical chronic pelvic pain
dysmenorrhoea
subfertility
26
Endometriosis cause cyclical pelvic pain, dysmenorrhoea, and subfertility. What other symptoms can it cause?
deep dyspareunia
dyschezia
cyclical haematuria / rectal bleeding
27
what investigation is diagnostic for endometriosis
laparoscopy
28
what staging is used for endometriosis
ASRM 1-4
29
why does endometriosis regress in menopause and pregnancy
oestrogen dependent
30
Endometriosis affects nulliparous women with genetic susceptibility.
Why does the mirena coil work as a treatment?
we don't know
31
3 forms of management for endometriosis
conservative
medical
surgical
32
describe to me the medical management of endometriosis
mimc pregnancy - COCP / POP / Depot Provera
mimic menopause - GnRh analogues
or Mirena!
33
what do you have to monitor if a lady with endometriosis is being treated with GnRH analogues?
bones for osteoporosis. DEXA scans. HRT add-back therapy to prevent.
34
what is the most common symptom of endometriosis
nothing!
35
surgical options for endometriosis?
endometrial ablation
| oophorectomy or pelvic clearance.
36
the endometrium can sometimes get trapped in the underlying myometrium, causing pockets of menstrual blood to get trapped. What's this called?
adenomyosis
37
what are the two main symptoms of adenomyosis
dull pain
| dysmenorrhoea
38
what are the investigations and treatment for adenomyosis?
MRI
| hysterectomy :(
39
which women get adenomyosis?
older women with lots of kids (scarring each time)
40
define utero-vaginal prolapse
descent of the uterus and/or vagina out of normal anatomical confines
41
as well as utero-vaginal prolapse, what other kinds of prolapse can you get
cystourethrocoele (bladder through vagina)
rectoceole
enterocoele (pouch of douglas)
vaginal vault prolapse
42
when would you get a vaginal vault prolapse?
after hyseterectomy
43
what are the risk factors for prolapse
older multips
chronic cough
surgery
obesity
44
name 4 symptoms of prolapse
lump coming down
dragging sensation
dyspareunia
splinting
45
what would you use to examine a lady with prolapse
Simms speculum (bulge visible)
46
Prolapse can be improved with weight loss, physio, and local oestrogen cream. What are the other treatments?
pessary
| surgery
47
what are the surgeries for prolapse
anterior/posterior repair
| vaginal hysterectomy
48
Risk factors for pelvic congestion syndrome include pregnancy and oestrogenny hormonal milieu. Name two other RFs
compression of outflow (fibroids, scarring)
| obstruction (Budd Chiari)
49
what is the investigation for pelvic congestion syndrome
transvaginal DOPPLER (shows venous reflux)
50
Women with pelvic congestion syndrome have chronic pelvic pain. When is it worse?
after long standing (better laid down)
| worse after sex or before period
51
In pelvic congestion syndrome the pain can be helped by NSAIDs. What are the other treatments?
```
GnRH analogues (change hormonal milieu)
surgical embolization of varices
```
52
give me an example of a GnRH analogues
goserelin
53
what SRNI can be used for urodynamic stress incontinence?
duloxetine
54
what surgeries for urodynamic stress incontinence
TVT (tension-free vaginal tape)
colposuspension
(bulkamid into urethra)
55
pelvic floor exercises and vaginal cones help with what
urodynamic stress incontinence
56
give two examples of urodynamics tests
```
flow meter (records info about urinary flow on chart)
cystometry
```
57
what is the diagnostic investigation for urodynamics stress incontinence
cystometry (the one with the graphs)
58
cystometry is the one with the graphs. what three pressures does it measure
bladder pressure
detrusor pressure
abdo pressure
59
what medication for urodynamic stress incontinence
duloxetine
60
urgency in absence of infection =?
overactive bladder
| usually detrusor overactivity
61
what investigations for overactive bladder
```
bladder diary
(only cystometry if failed treatment)
```
62
what will bladder diary of patient with overactive bladder show?
frequent small vols often at night
63
decreasing caffeine and doing bladder drill are conservative treatments for what
overactive bladder
64
give me two examples of anti-cholinergics for overactive bladder
oxybutynin
| solefenacin
65
for overactive bladder, decrease caffine, bladder drill, anti-cholinergics. What other medication could you try?
MIRABEGRON (b3 agonist - relaxes detrusor)
66
severe overactive bladder, could try botox injections to relax detrusor. what is the side effect of this?
retention
67
what is the normal residual bladder vol
0ml
68
Ovarian cyst usually just watchful waiting (ultrasounds) . when would you operate on ovarian cyst
>5cm / malig risk / symptomatic
69
30 yr old with sudden onset unilateral lower abdo pain after strenuous activity. worsening intermittently over many hours. likely diagnosis?
ovarian torsion
70
what investigation for ovarian torsion
doppler US. CSR, WCC.
| LAPAROSCOPY DIAGNOSTIC
71
what 2 surgeries for ovarian cyst
laparoscopic cystectomy
| ooporectomy
72
hypovolaemic shock can be outcome of which ovarian cyst complication
haemorrhage
73
peritonitis can be outcome of which ovarian cyst complication
rupture
74
treatment for ovarian cyst rupture
washout
| or just pain relief
75
treatment for ovarian torsion
laparscopy - untwist
76
A medical termination of pregnancy takes place in two appointments. In appointment 1, the patient is given _____, and in appointment 2, the patient is given ____.
1) oral mifepristone
| 2) vaginal misoprostol
77
What kind of drug is mifepristone?
anti-progesterone
| miffed at prigisterone
78
What kind of drug is misoprostol?
PROSTaglandin
79
What does the method of termination of pregnancy depend on?
number of weeks, and patient choice.
<9wks, usually medical
7-13wks: suction curettage
>13wks: D&E
80
if the gestation is >22wks, what drug must the patient be given to prevent live birth?
KCl injection
81
7-13wks, surgical TOP. What is the method?
suction curettage
82
>13wks, surgical TOP. What is the method?
dilatation and evacuation
83
why do you give pre-op misoprostol before dilatation & evacuation?
ripen cervix
84
Why do you give antibiotic prophylaxis in TOP?
prevent PID
85
What are the potential complications from surgical termination of pregnancy?
- PID
- uterine perforation
- cervical trauma
- excessive bleeding
86
What are the potential complications from medical termination of pregnancy?
- failure of TOP
- retained tissue
- excessive bleeding
- emotional distress
87
What is clause C of the Abortion Act 1967
not past 24wks and injury to physical/mental health of woman
88
What happens if a smear is reported as borderline or mild dyskaryosis?
the original sample is tested for HPV
if HPV negative the patient goes back to routine recall
if HPV positive the patient is referred for colposcopy
89
what percent of women of reprod age are affected by PCOS?
10%
90
define PCO (polycystic ovaries)
>_ 12 follicles in enlarged >10ml ovary
91
GIVE ME FIVE SYMPTOMS OF PCOS
```
acne
hirsutism
obesity
oligomenorrhoea
infertility
```
92
What condition are the Rotterdam criteria used to diagnose ?
PCOS
93
There are three Rotterdam criteria for diagnosing PCOS. What are they? :)
1. SCAN - shows polycystic ovaries
2. PERIODS - irregular / absent
3. ANDROGENS - raised, clinically/biochemically
94
One of Rotterdam criteria for diagnosing PCOS is "raised androgens"... how can you ascertain this?
a) clinically - acne, hirsutism
| b) biochemically - raised serum TESTosterone
95
To investigate PCOS you would do transvaginal US, and oral glucose tolerance test. You would also do a lot of bloods. What are they and what would they show?
LH + testosterone - raised
| FSH, prolactin, TSH - normal
96
Why do you do oral glucose tolerance in investigating PCOS?
INSUUULIN RESIIIISTANCE
97
Investigations for PCOS?
oral GTT
transvaginal US
LH, testosterone
FHS, prolactin, TSH
98
Insulin resistance and increased LH production combine to cause excess androgen production (by ovaries and elsewhere). What is this condition?
PCOS
99
What two things combine to cause excess androgen production in PCOS?
insulin resistance
| increased LH production
100
Three things are the mainstay of PCOS treatment. Please tell me them Kate.
1. normalise weight
2. Dianette COCP
3. anti-androgens
101
Give me two examples of anti-androgens (for treating PCOS)
cyproterone acetate
| spironolactone
102
What does the Dianette COCP contain? (used for treating PCOS)
```
cyproterone acetate (anti-androgen)
+ oestrogen
```
103
What if a lady with PCOS wants to get pregnant? She's not ovulating so you need to give her something for ovulation.
CLOMIFENE
| selective oestrogen receptor modulator
104
What if PCOS is really severe or at high risk of diabetes?
METFORMIN
105
When do you give metformin in PCOS?
if rlly severe or at high risk of diabetes
106
Give me two big complication of PCOS
DIABETES (T2DM, gestational DM)
| Endometrial cancer.
