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SamerZ > GYN 1 > Flashcards

GYN 1 Flashcards

1
Q

What amount of blood is considered as HMB?

A

75ml

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2
Q

Role of examination in HMB?

A

Examination can be skipped in the absence symptoms suggestive of structural pathologies..
Unless IUD is to be inserted then examination is a must

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3
Q

What investigations to do for women with HMB?

A

CBC
Coagulation profile (teens, RO VW)
No need for ferritin
No need fir FSH LH
Thyroid hormone only if symptomatic

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4
Q

What are the first line investigations (imaging) in case of HMB?

A
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5
Q

Can we use pipelle for premenopausal with HMB?

A

No

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6
Q

When to do pelvic US in the setting of HMB (rather than hysteroscopy)

A
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7
Q

When to consider abdominal US in the investigation of HMB (instead of TVS)?

A

When uterus is bulky (12w)
History of dysmenorrhea ( suggesting adenomyosis)

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8
Q

Other imaging in HMB

A

No role for saline infusion sonography
MRI not for first line
Don’t use D&C for diagnosis

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9
Q

LNG-IUS for the tt of HMB.. what to expect?

A

Cannot be put without proper examination
Anticipate changes in bleeding pattern till 6 months
Wait at least 6 months to see results before labeling this as treatment failure
Offer this option if the patient wants at least 1 year gap without getting pregnant

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10
Q

1st line surgical treatment for HMB after medical failure

A

Endometrial ablation.
Avoid subsequent pregnancy

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11
Q

What is the definitive surgical treatment for patients with HMB?

A

Hysterectomy
Vaginal better than abdominal better than laparoscopic
Buzz word (definitive)

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12
Q

Treatment guideline for HMB, fibroid less than 3cm, or suspected adenomyosis

A
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13
Q

Treatment of HMB with a fibroid of more than 3cm?

A

1.pressure, completed family, Jehovah’s witness, wants to avoid surgery: UAE
2.fertility is desired: myomectomy
3. Hct less than 102, size more than 3: Ulipristal acetate
4.UAE is a fast way to decrease pressure symptoms

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14
Q

About Ulipristal acetate

A

Can cause liver injury
Liver function test monthly for the first 2 courses
5mg daily up to 4 courses then surgery

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15
Q

HMB acute/initial management

A

Tranexamic acid

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16
Q

Less than 3cm fibroid intact cavity

A

IUS

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17
Q

3cm fibroid Hb less than 102

A

Ulipristal acetate

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18
Q

Less than 3cm fibroid, uterus less than 10 cm and ET more than 8mm

A

Endometrial ablation

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19
Q

Lifetime prevalence of fibroid

A

30%
25% of them are symptomatic

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20
Q

Role of GNRH in fibroid treatment

A

36% reduction and fibroid size
Improvement of symptoms after 12 weeks
Menstruation returns and 4 to 8 weeks
Fibroid size returns to normal in 4 to 6 months

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21
Q

Can SPRM be used for the treatment of fibroid?

A

Yes
We can use Ulipristal acetate but no Mifepristone.

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22
Q

How to choose between tranexamic acid amd mefamanic acid in the management of heavy menstrual bleeding as a non hormonal treatment?

A

Use tranexamic acid if only bleeding exist
Use NSAID if bleeding and pain

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23
Q

Can we perform endometrial ablation when we have the fibroid more than 3 cm in size?

A

Considered endometrial ablation anytime high risk endometrial cancer exists
Consider ablation even before medical treatment when fibroid is less than 3 cm and symptoms are severe

24
Q

What is the prerequisite to do uterine artery embolization?

A

We should consider MRI mapping of the fibroids

25
Q

What are the absolute contradications for uterine artery embolization?

A

Any evidence of current or recent infection Serious doubt of the diagnosis
Pregnancy
Asymptomatic fibroids
If the patient refuses radically hysterectomy

26
Q

What are the relative contraindication for uterine artery Embolization?

A

Pedunculated fibroid
Submucosal big fibroid
Desire for fertility

27
Q

What are the chances that the patient who underwent uterine artery embolization requires further intervention?

A

Within 5 years:
25% for patients less than 40 years
10% for those between 40 and 50

28
Q

What is the difference between a fibroid uterus and adenomayosis?

A

Fibroid uterus is more prevalent in nulliparous as present with an irregular mass
Adenomyosis more likely in multiparous women presents with the bulky uterus, homogeneous, dysmenorrhea and tenderness on palpation

29
Q

What are the common pathologies seen Concomitantly with adenomaiosis?

A
  1. Fibroid
  2. Endometriosis
30
Q

What is the prevalence of PMS?

A

40%
5 to 8% severe PMS

31
Q

How to diagnose PMS?

A

PMS diary of two cycles
If inconsistent then GNRH analogue may be used for 3 months

32
Q

Initial treatment of PMS by GP

A

COC
Vitamin B6
Low dose SSRI
CBT

33
Q

Hormonal treatment of PMS

A

Drospirenon-containing COC
Continuous rather than cyclically
IUS can cause PMS like symptoms
Percutaneous estradiol + cyclic micronized progesterone (minimal PMS like symptoms)

34
Q

When to use Danazol in the treatment of PMS?

A

For breast symptoms

35
Q

When to use GnRH in the treatment of PMS?

A

For refractory cases
Add-back therapy is needed after 6 months

36
Q

Surgical treatment for PMS

A

Should always use GnRH pre-op as a test of cure and to make sure that HRT is tolerated

37
Q

Best treatment PMS

A

Low dose SSRI

38
Q

PMS and requires contraception

A

COC

39
Q

PMS with only breast symptoms

A

Danazol

40
Q

If only mild psychological symptoms in PMS

A

CBT

41
Q

SSRI contraindicated with tamoxifen, true or false?

A

True
Drug drug interaction

42
Q

What subtype of PCOS patients should be screened for diabetes?

A

BMI more than 25
If BMI less than 25 should have one of the following factors:
- age more than 40
-Personal history of gestation diabetes
-Family history of type 2 diabetes

43
Q

What are the initial steps to take for PCOS patients?

A

Lifestyle changes including diet, exercise and weight loss

44
Q

Is metformin indicated in the treatment of PCOS?

A

No

45
Q

Surgical treatment for PCOS

A

Ovarian drilling

46
Q

Prevalence of PCOS
Prevalence of metabolic syndrome among PCOS

A

10-18%
33% of them have metabolic syndrome

47
Q

How to diagnose PCOS in adolescent?

A

We should have three out of three Rotterdam criteria

48
Q

What are the screening tests to perform for PCOS patients?

A

Cigarette smoking every visit
Obesity check every visit
Blood pressure check annually for lowest patients and that every visit if BMI more than 25
Lipid profile every 2 years for low risk annually for women with abnormal profile
Glucose tolerance test 75 g every 2 years for all woman and every year for high risk patients. (Age more than 40 smoking obese hypertensive previously gestation diabetes family history of diabetes)

49
Q

Differential diagnosis and management of oligomenorrhea

A

It can be PCOS (obesity hirsutism and subfertility)
It can be thyroid problem
It can be prolactin normal (headache breast discharge problems with vision)
It can be premature ovarian failure (hot flushes, high FSH)

50
Q

Hirsutism managment in young women

A
51
Q

Evaluation of hirsutism

A
52
Q

Definition of chronic pelvic pain

A

More than 6 months duration

53
Q

ROME 3 criteria for IBS

A

Abdominal pain on at least 3 days a month in the last 3 months, with onset at least 6 months previously, associated with 2 out of these:
Improve with defecation
Onset associated with change in frequency of stool
Onset associated with a change in form of stool

54
Q

1st on the differential diagnosis of chronic pelvic pain in patients younger than 25

A

R/O PID and ask for STD pannel

55
Q

Initial management of chronic pelvic pain:

A

If cyclic pain: 3 to 6 months of hormonal treatment before having a diagnostic laparoscopy.

SamerZ (3 decks)

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