Gyn Flashcards
Diagnostic criteria for PCOS
Rotterdam Criteria
2/3 of
Clinical: Hirsutism or oligo-anovulation
Biochemical:Hyperandrogenism
Imaging: 12+ follicles of 2-9mm OR ovarian volume >10ml in one ovary
Difference between Pap smear and cervical screening
Pap smear looks for abnormal cells/metaplasia
Cervical screening looks for the HPV itself
Treatments for PCOS
FIRST LINE is weight loss target BMI. <25
Not planning for pregnancy
1)COCPs
2)Metformin
1)Aromatase inhibitors: Letrozole or clomiphene
2)exogenous gonadotropins
3)Metformin
4)laparoscopic ovarian drilling
5)IVF
Complications of PCOS
1)Irregular periods or amenorrhea
2) Difficulty with conception/fertility
3)ACNE and hirsutism
4)Metabolic syndrome: T2DM and obesity
5)Risk factor for endometrial cancer
6)CVD
7)Pregnancy loss
Difference between Tranexamic acid(TXA) and mefenamic acid(MFA)
TXA is an anti fibrinolyic for heavy bleeding
MFA is a Cox-2/PG inhibitor that as acts as pain relief
COCPs effect on cancer risk
Decreases risk of endometrial and ovarian Ca
Increases risk of breast and cervical Ca
Diagnosis of endometriosis
Clinical
-Fixed uterus
-Vaginorectal and uterosacral tenderness and nodularity on DRE
-laterally displaced cervix
-adnexal tenderness and masses
US pelvis: chocolate cysts
Lapascopy: ectopic endometrioma
What can Alpha feto protein be used a s a tumour marker for
Yolk sac tumour(Ovarian Ca) as well as HCC
When do protein S deficiency related miscarriages occur
2nd trimester
Cause of strawberry cervix and treatment
Trichomonas vaginalis infection->PO metronidazole
Causes of oligomenorrhea/ secondary amenorrhea
HPOA Axis
H: Physical, emotional, mental stress, antipsychotic drugs
P: Pituitary adenoma
O: PCOS,Premature ovarian failure(Idiopathic,Iatrogenic,thyroid dysfn, vasculitis)
tibolone contraindications
?
Drug to reduce HIV viral load in pregnancy
Zidovudine
Criteria for aspirin in early pregnancy
Major criteria
1. Previous Pre eclampsia
2. Pre gestational DM
3. Thrombophilia(APS, Protein C,S or anti thrombin iii deficiency,SLE)
4. Chronic HTN
5. CKD
Minor
1. Advanced maternal age >40
2. Obesity BMI >35
3. Nulliparity
4. Pregnancy interval >10years
5. FHx of pre eclampsia
6. Multiple pregnancy
Groups of causes of female infertility
Tubal causes
Ovarian causes
Uterine causes
Ovulatory/HPOA
Tubal causes of female infertility
Ectopic pregnancies/salpingectomy
Endometriosis
Pelvic inflammatory disease
Tubal ligation
Ovarian causes of female infertility
Low ovarian reserve
Uterine causes of female infertility
Endometrial polyps
Submucosal fibroids
Ashermanns syndrome
Ovulatory/HPOA causes of infertility
Ovarian:
PCOS
Premature ovarian failure
Chromosomal eg Turners
Hypothalamic
Idiopathic hypogonadotrophic hypogonadism
Groups of causes of recurrent pregnancy loss
- Problems with placental perfusion
- Uterine issues
- Chromosomal abnormalities
Causes of male infertility
Pre Testicular
-hypothalamic hypogonadism,Kallmans syndrome
-Pituitary: hyperprolactinemia
-Exogenous hormones
-Thyroid dysfunction
Testicular
-congenital: Klinefelter or y chromosome microdeletion
-Acquired: Trauma, infection,varicocele, chemo/surg
Post testicular
-Vasectomy
-Cystic fibrosis
High risk surgical-pathological features of endometrial cancer
> 2cm
=50% myoinvasion
Cervix involvement
Histo shows
i) grade 3 endometroid
ii) clear cell
iii)serous
Endometrial Ca staging
FIGO staging
I: confined to uterus
II: extension to cervix
III: extension to pelvis
IV: Local or distant metastasis eg rectum,bladder
Most common cause of post menopausal bleeding
Atrophic vaginitis
BUT endometrial ca until proven otherwise
Cardinal signs and Sx of ovarian Ca
Nausea/Vomiting
Bloatedness
Distension
Pelvi-Abdominal mass
Urinary urgency/frequency
Early satiety/LOA/LOW
Generally NOT a/w uterine bleeding
RFs of ovarian Ca
Also unopposed hyperestrogenism
Nulliparity
Early menarche
Late menopause
Endometriosis
Genetic
BCRA ½
HNPCC
Peutz Jeghers syndrome
For ovarian cystectomy, why are the ovaries preserved if possible
To avoid early menopause and increased risk of cardiovascular disease
Antibiotics for Pelvic Inflammatory
Ceftriaxone
Doxycycline
Metronidazole
Gold standard for emergency contraception
Intra Uterine Copper Device
What is in the morning after pill
Ulipristal, a progesterone receptor modulator
What is used in a endometrial sampling
Pipelle biopsy
