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CP2 Obs & Gynae > General gynaecology > Flashcards

General gynaecology Flashcards

1
Q

DDx for intermenstural bleeding

A
  • cervical malignancy
  • cervical ectropion
  • endocervical polyp
  • atrophic vaginitis
  • pregnancy
  • irregular bleeding related to contraceptive pill
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2
Q

Drugs associated with hyperprolactinaemia (due to dopamine agonist effects)?

A
  • metoclopramide
  • phenothiazines (e.g. chlorpromazine, prochlorperazine, thioridazine)
  • reserpine
  • methyldopa
  • omeprazole, ranitidine, bendrofluazide (rare)
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3
Q

Effects of premature menopause

A

Hypo-oestrogenic effects:

  • vaginal dryness
  • vasomotor symptoms (hot flushes, night sweats)
  • increased cardiovascular risk

Psychological and social effects:

  • infertility
  • feeling of inadequacy as a woman
  • feelings of premature ageing and need to take HRT
  • impact on relationships
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4
Q

Treatment of anovulation?

A

Clomifene citrate

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5
Q

How is anovulation shown on investigations?

A

Progesterone level below 30nmol/L

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6
Q

What is a non-specific marker for ovarian carcinoma??

A

CA-125

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7
Q

Typical presentations of fibroids

A
  • menorrhagia
  • abdominal mass
  • pressure effect from pressure on the bladder, stomach or bowel
  • infertility
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8
Q

What advice should you give after LLETZ procedure

A
  • patient may have light bleeding for several days
  • if heavy bleeding occurs, should return as secondary infection may occur and need treatment
  • avoid sexual intercourse and tampon use for 4 weeks, to allow healing of the cervix
  • fertility is generally unaffected by the procedure, though cervical stenosis leading to infertility has been reported. Mid-trimester loss from cervical weakness is rare
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9
Q

After LLETZ, when should the follow up smears be?

A

6 months, and then yearly smears for 10 years

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10
Q

What is dysfunctional uterine bleeding?

A

Excessive heavy, prolonged or frequent bleeding that is not due to pregnancy or any recognisable pelvic or systemic disease

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11
Q

What should always be measured in a woman with amenorrhoea?

A

Prolactin

May have a pituitary adenoma (prolactinoma).

NB levels up to 1000mu/L can be found as a result of stress, breast examination or PCOS. Above 1000mu/L is usually a pituitary adenoma

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12
Q

DDx of secondary amenorrhoea

A 
Hypothalamic
- chronic illness
- anorexia
- excessive exercise
- stress
Pituitary
- hyperprolactinaemia (drugs, tumour)
- hypothyroidism
- breast feeding
Ovarian
- PCOS
- premature ovarian failure
- iatrogenic (chemo/radiotherapy, oophorectomy)
- long-acting progesterone contraception
Uterine
- pregnancy
- Asherman's syndrome
- cervical stenosis
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13
Q

Causes of post-menopausal bleeding

A

PMB is considered to be caused by endometrial cancer until proven otherwise.
Others:
- endometrial/endocervical polyp
- endometrial hyperplasia
- atrophic vaginitis
- iatrogenic (anticoagulants, intrauterine device, HRT)
- infective (vaginal candidiasis)

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14
Q

Causes of dysmenorrhoea

A
  • idiopathic
  • premenstural syndrome
  • pelvic inflammatory disease
  • endometriosis
  • adenomyosis
  • subcostal pedunculated fibroids
  • iatrogenic (e.g. intrauterine contraceptive device, or cervical stenosis after LLETZ
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15
Q

DDx of postcoital bleeding in a young woman

A
  • cervical ectropion
  • chlamydia or other STIs
  • cervical maligancy
  • complication of the COCP
  • endocervical polyp
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16
Q

What consists of an STI screen?

A
  • endocervical swab for chlamydia - 30 secs
  • endocervical swab for gonorrhoea
  • high vaginal swab for trichomonas (and candida)
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17
Q

Diagnosis of antiphospholipid syndrome

A

Presence of one of the clinical features:
- three or more consecutive miscarriages
- mid-trimester fetal loss
- severe early-onset pre-eclampsia, IUGR or abruption
- arterial or venous thrombosis
AND haematological features:
- anticardiolipin antibody or lupus anticoagulant detected on two occasions at least 6 weeks apart

18
Q

What is antiphospholipid syndrome often secondary to?

A

Systemic lupus erythematosus (SLE)

19
Q

What is the management of antiphospholipid syndrome?

A

Oral low dose aspirin and low-molecular-weight subcutaneous heparin from the time of a +ve pregnancy test, to improve the likelihood of a successful live birth

20
Q

Causes of recurrent miscarriage

A
  • parental chromosome abnormality
  • antiphospholipid syndrome
  • other thrombophilia (e.g. activated protein C resistance)
  • uterine abnormality (intracavity fibroids, uterine septum)
  • uncontrolled diabetes or hypothyroidism
  • bacterial vaginosis (usually associated with second-trimester loss)
  • cervical weakness (‘incompetence’, second-trimester loss only
21
Q

How is prolapse categorised?

A

According to the level of descent of the cervix in relation to the introitus

22
Q

What are the degrees of prolapse?

A

First degree: descent within the vagina
Second degree: descent to the introitus
Third degree: descent of the cervix outside the vagina
Procidentia: complete eversion of the vagina outside the introitus

23
Q

Management of hypovolaemic shock with hypokalaemia?

A
  • supportive management
  • monitor electrolytes
  • fluid restriction
  • potassium supplementation
  • ECG monitoring until K+ is normal
  • HDU and oxygen
  • monitor ABG
24
Q

What should PMB be considered to be?

A

Endometrial carcinoma until proven otherwise

25
Q

Risk factors of endometrial carcinoma?

A
  • T2DM
  • obesity
  • nulliparity
26
Q

Management of endometrial carcinoma?

A
  • simple total abdominal hysterectomy and bilateral salpingoophorectomy
  • 90% present in early stage
27
Q

Stages of endometrial cancer:

A

histologically staged
- stage 1: confined to the body of the uterus
1a limited to endometrium
1b invasion only of the inner half of the myometrium
1c invasion to the outer half of the myometrium
- stage 2: involving the uterus and cervix only
- stage 3: extending beyond the uterus but not beyond the true pelvis
- stage 4: extending beyond the true pelvis into the bladder or rectum

28
Q

What is the true pelvis?

A

pelvic inlet

29
Q

Prognosis of endometrial carcinoma?

A
  • > 70% survival at 5y for stage 1 disease

- 10% survival at 5y for stage 4 disease

30
Q

What is Fitz-Hugh-Curtis syndrome?

A

The presence of perihepatic adhesions in association with previous chlamydial or gonoccocal infection

31
Q

How do you manage pelvic adhesions?

A
  • laparoscopic adhesiolysis
  • pain management: analgesics or possible uterosacral nerve ablation
  • treat both partners for course of abx in case still infected
32
Q

What are the long term complications of PID?

A
  • chronic pain
  • infertility - tubal
  • ectopic pregnancy

nb can still have spontaneous pregnancy so stay on contraception if you don’t wanna get pregger

33
Q

How is Turner’s syndrome managed?

A

Psychological etc family counselling … etc
Medical:
- human growth hormone to achieve full height potential
- oestrogen therapy with ethinyl estradiol to enable secondary sexual characteristics (breasts and pubic and axillary hair)
- cyclical progestrogens added later to induce withdrawal bleed (period) for social reasons and to protect endometrium from hyperplasia or malignancy in long run
- oestrogen therapy until menopause age to prevent early-onset osteoporosis
Fertility:
- options available with ovum donation and hormonal support

34
Q

DDx of irregular bleeding with COCP if examination is normal

A
  • poor compliance
  • concurrent antibiotics
  • diarrhoea or vomiting
  • infection (chlamydia, gonorrhoea or candida)
  • cervical ectropion
  • bleeding diathesis
  • drug interactions (e.g. antiepileptics
35
Q

Management of endometrial polyp?

A

Avulsion in OPC under speculum examination

  • polyp is grasped with forceps and twisted repeatedly until it detaches at base
  • any remnant generally necroses and disappears
  • always send for histological examination
36
Q

What medication is effective in many women with PMS?

A

SSRIs

37
Q

What are the possible treatment options for cervical carcinoma?

A
  • radical hysterectomy (up to stage 1b)
  • trachelectomy
  • radiotherapy (beyond stage 1b and post menopausal)
38
Q

Management of stress incontinence?

A

Conservative

  • lifestyle
  • reduce weight
  • stop smoking (cough)
  • alter diet and consider laxatives to avoid constipation
  • pelvic floor exercises

Surgical

  • transvaginal or transobturator vaginal tape
  • colposuspension
39
Q

What is precocious puberty?

A

Periods starting before the age of 9 years

40
Q

Causes of precocious puberty?

A
  • constitutional (90%)
  • hypothyroidism
  • CNS lesions (hydrocephaly, neurofibromatosis)
  • ovarian tumour
  • adrenal tumour
  • exogenous oestrogens

CP2 Obs & Gynae (6 decks)

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