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Gynaecology > General gynae > Flashcards

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)

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2
Q

What proportion of women have menorrhagia

A

one third

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3
Q

What are the investigations for menorrhagia for under 45s

A

FBC, transvaginal US

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4
Q

What are the investigations for menorrhagia for >45s

A

FBC, transvaginal US, endometrial biopsy

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5
Q

3 options for medical treatment of menorrhagia

A
  1. Mirena / COCP
  2. antifibrinolytics + NSAIDs
  3. progestogens (oral/IM)
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6
Q

name an antifibrinolytic for menorrhagia

A

tranexamic acid

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7
Q

name an NSAID for menorrhagia

A

mefenamic acid

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8
Q

name a progestogen for menorrhagia

A

norethisterone

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9
Q

give me two surgical options for menorrhagia

A

endometrial ablation

hysterectomy

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10
Q

what is the posh name for fibroids

A

leiomyoma

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11
Q

what actually are fibroids?

A

benign myometrium tumours

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12
Q

what proportion of women under 30 have fibroids

A

one third

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13
Q

give me 4 sites for fibroids

A

intracavity
submucosal
intramural
subserosal

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14
Q

FHx, nulliparous, near menopause, afro-Caribbean are all risk factors for …

A

fibroids

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15
Q

Half of fibroids are asymptomatic. True or false?

A

true!

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16
Q

what two key symptoms do fibroids cause

A

menorrhagia

dysmenorrhoea

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17
Q

why can fibroids cause frequency and infertility

A

press on bladder

prevent implantation

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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

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19
Q

Give me the main surgical option for fibroids

A

MYOMECTOMY
if small - hysteroscopic resection
if completed fam - hysterectomy

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20
Q

Haemorrhage and torsion are two complications of fibroids. Name two others;

A

red degeneration in pregnancy

leiomyosarcoma

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21
Q

what happens to size of fibroids in pregnancy

A

they might grow, shrink or stay the same!

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22
Q

why do fibroids regress in menopause

A

oestrogen dependent

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23
Q

define endometriosis

A

growth of endometrium tissue outside uterus!

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24
Q

where can endometriosis spread to

A

OVARIES
UTEROSACRAL LIGAMENTS
abdo scars, rectum, bladder
(can even spread in lymph to lungs)

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25
Q

give me the THREE KEY symptoms of endometriosis

A

cyclical chronic pelvic pain
dysmenorrhoea
subfertility

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26
Q

Endometriosis cause cyclical pelvic pain, dysmenorrhoea, and subfertility. What other symptoms can it cause?

A

deep dyspareunia
dyschezia
cyclical haematuria / rectal bleeding

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27
Q

what investigation is diagnostic for endometriosis

A

laparoscopy

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28
Q

what staging is used for endometriosis

A

ASRM 1-4

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29
Q

why does endometriosis regress in menopause and pregnancy

A

oestrogen dependent

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30
Q

Endometriosis affects nulliparous women with genetic susceptibility.
Why does the mirena coil work as a treatment?

A

we don’t know

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31
Q

3 forms of management for endometriosis

A

conservative
medical
surgical

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32
Q

describe to me the medical management of endometriosis

A

mimc pregnancy - COCP / POP / Depot Provera
mimic menopause - GnRh analogues
or Mirena!

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33
Q

what do you have to monitor if a lady with endometriosis is being treated with GnRH analogues?

A

bones for osteoporosis. DEXA scans. HRT add-back therapy to prevent.

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34
Q

what is the most common symptom of endometriosis

A

nothing!

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35
Q

surgical options for endometriosis?

A

endometrial ablation

oophorectomy or pelvic clearance.

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36
Q

the endometrium can sometimes get trapped in the underlying myometrium, causing pockets of menstrual blood to get trapped. What’s this called?

A

adenomyosis

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37
Q

what are the two main symptoms of adenomyosis

A

dull pain

dysmenorrhoea

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38
Q

what are the investigations and treatment for adenomyosis?

A

MRI

hysterectomy :(

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39
Q

which women get adenomyosis?

A

older women with lots of kids (scarring each time)

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40
Q

define utero-vaginal prolapse

A

descent of the uterus and/or vagina out of normal anatomical confines

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41
Q

as well as utero-vaginal prolapse, what other kinds of prolapse can you get

A

cystourethrocoele (bladder through vagina)
rectoceole
enterocoele (pouch of douglas)
vaginal vault prolapse

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42
Q

when would you get a vaginal vault prolapse?

A

after hyseterectomy

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43
Q

what are the risk factors for prolapse

A

older multips
chronic cough
surgery
obesity

44
Q

name 4 symptoms of prolapse

A

lump coming down
dragging sensation
dyspareunia
splinting

45
Q

what would you use to examine a lady with prolapse

A

Simms speculum (bulge visible)

46
Q

Prolapse can be improved with weight loss, physio, and local oestrogen cream. What are the other treatments?

A

pessary

surgery

47
Q

what are the surgeries for prolapse

A

anterior/posterior repair

vaginal hysterectomy

48
Q

Risk factors for pelvic congestion syndrome include pregnancy and oestrogenny hormonal milieu. Name two other RFs

A

compression of outflow (fibroids, scarring)

obstruction (Budd Chiari)

49
Q

what is the investigation for pelvic congestion syndrome

A

transvaginal DOPPLER (shows venous reflux)

50
Q

Women with pelvic congestion syndrome have chronic pelvic pain. When is it worse?

A

after long standing (better laid down)

worse after sex or before period

51
Q

In pelvic congestion syndrome the pain can be helped by NSAIDs. What are the other treatments?

A 
GnRH analogues (change hormonal milieu)
surgical embolization of varices
52
Q

give me an example of a GnRH analogues

A

goserelin

53
Q

what SRNI can be used for urodynamic stress incontinence?

A

duloxetine

54
Q

what surgeries for urodynamic stress incontinence

A

TVT (tension-free vaginal tape)
colposuspension
(bulkamid into urethra)

55
Q

pelvic floor exercises and vaginal cones help with what

A

urodynamic stress incontinence

56
Q

give two examples of urodynamics tests

A 
flow meter (records info about urinary flow on chart)
cystometry
57
Q

what is the diagnostic investigation for urodynamics stress incontinence

A

cystometry (the one with the graphs)

58
Q

cystometry is the one with the graphs. what three pressures does it measure

A

bladder pressure
detrusor pressure
abdo pressure

59
Q

what medication for urodynamic stress incontinence

A

duloxetine

60
Q

urgency in absence of infection =?

A

overactive bladder

usually detrusor overactivity

61
Q

what investigations for overactive bladder

A 
bladder diary
(only cystometry if failed treatment)
62
Q

what will bladder diary of patient with overactive bladder show?

A

frequent small vols often at night

63
Q

decreasing caffeine and doing bladder drill are conservative treatments for what

A

overactive bladder

64
Q

give me two examples of anti-cholinergics for overactive bladder

A

oxybutynin

solefenacin

65
Q

for overactive bladder, decrease caffine, bladder drill, anti-cholinergics. What other medication could you try?

A

MIRABEGRON (b3 agonist - relaxes detrusor)

66
Q

severe overactive bladder, could try botox injections to relax detrusor. what is the side effect of this?

A

retention

67
Q

what is the normal residual bladder vol

A

0ml

68
Q

Ovarian cyst usually just watchful waiting (ultrasounds) . when would you operate on ovarian cyst

A

> 5cm / malig risk / symptomatic

69
Q

30 yr old with sudden onset unilateral lower abdo pain after strenuous activity. worsening intermittently over many hours. likely diagnosis?

A

ovarian torsion

70
Q

what investigation for ovarian torsion

A

doppler US. CSR, WCC.

LAPAROSCOPY DIAGNOSTIC

71
Q

what 2 surgeries for ovarian cyst

A

laparoscopic cystectomy

ooporectomy

72
Q

hypovolaemic shock can be outcome of which ovarian cyst complication

A

haemorrhage

73
Q

peritonitis can be outcome of which ovarian cyst complication

A

rupture

74
Q

treatment for ovarian cyst rupture

A

washout

or just pain relief

75
Q

treatment for ovarian torsion

A

laparscopy - untwist

76
Q

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 ____.

A

1) oral mifepristone

2) vaginal misoprostol

77
Q

What kind of drug is mifepristone?

A

anti-progesterone

miffed at prigisterone

78
Q

What kind of drug is misoprostol?

A

PROSTaglandin

79
Q

What does the method of termination of pregnancy depend on?

A

number of weeks, and patient choice.

<9wks, usually medical
7-13wks: suction curettage
>13wks: D&E

80
Q

if the gestation is >22wks, what drug must the patient be given to prevent live birth?

A

KCl injection

81
Q

7-13wks, surgical TOP. What is the method?

A

suction curettage

82
Q

> 13wks, surgical TOP. What is the method?

A

dilatation and evacuation

83
Q

why do you give pre-op misoprostol before dilatation & evacuation?

A

ripen cervix

84
Q

Why do you give antibiotic prophylaxis in TOP?

A

prevent PID

85
Q

What are the potential complications from surgical termination of pregnancy?

A
  • PID
  • uterine perforation
  • cervical trauma
  • excessive bleeding
86
Q

What are the potential complications from medical termination of pregnancy?

A
  • failure of TOP
  • retained tissue
  • excessive bleeding
  • emotional distress
87
Q

What is clause C of the Abortion Act 1967

A

not past 24wks and injury to physical/mental health of woman

88
Q

What happens if a smear is reported as borderline or mild dyskaryosis?

A

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
Q

what percent of women of reprod age are affected by PCOS?

A

10%

90
Q

define PCO (polycystic ovaries)

A

> _ 12 follicles in enlarged >10ml ovary

91
Q

GIVE ME FIVE SYMPTOMS OF PCOS

A 
acne
hirsutism
obesity
oligomenorrhoea
infertility
92
Q

What condition are the Rotterdam criteria used to diagnose ?

A

PCOS

93
Q

There are three Rotterdam criteria for diagnosing PCOS. What are they? :)

A
  1. SCAN - shows polycystic ovaries
  2. PERIODS - irregular / absent
  3. ANDROGENS - raised, clinically/biochemically
94
Q

One of Rotterdam criteria for diagnosing PCOS is “raised androgens”… how can you ascertain this?

A

a) clinically - acne, hirsutism

b) biochemically - raised serum TESTosterone

95
Q

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?

A

LH + testosterone - raised

FSH, prolactin, TSH - normal

96
Q

Why do you do oral glucose tolerance in investigating PCOS?

A

INSUUULIN RESIIIISTANCE

97
Q

Investigations for PCOS?

A

oral GTT
transvaginal US
LH, testosterone
FHS, prolactin, TSH

98
Q

Insulin resistance and increased LH production combine to cause excess androgen production (by ovaries and elsewhere). What is this condition?

A

PCOS

99
Q

What two things combine to cause excess androgen production in PCOS?

A

insulin resistance

increased LH production

100
Q

Three things are the mainstay of PCOS treatment. Please tell me them Kate.

A
  1. normalise weight
  2. Dianette COCP
  3. anti-androgens
101
Q

Give me two examples of anti-androgens (for treating PCOS)

A

cyproterone acetate

spironolactone

102
Q

What does the Dianette COCP contain? (used for treating PCOS)

A 
cyproterone acetate (anti-androgen)
\+ oestrogen
103
Q

What if a lady with PCOS wants to get pregnant? She’s not ovulating so you need to give her something for ovulation.

A

CLOMIFENE

selective oestrogen receptor modulator

104
Q

What if PCOS is really severe or at high risk of diabetes?

A

METFORMIN

105
Q

When do you give metformin in PCOS?

A

if rlly severe or at high risk of diabetes

106
Q

Give me two big complication of PCOS

A

DIABETES (T2DM, gestational DM)

Endometrial cancer.

Gynaecology (8 decks)

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