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2020 Phase 3a (DB) > gyn2 > Flashcards

gyn2 Flashcards

1
Q

how might ovarian cyst present?

A 
swollen abdo
palpable pelvic mass
abdo pain
tender adenxae
dyspareunia
bloating, nausea
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2
Q

how can ovarian cysts affect ureters?

A

hydronephrosis
recurrent UTI
haematuria

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3
Q

how might ovarian cyst rupture present?

A

shock
peritonism
torsion - severe pain

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4
Q

how might functional ovarian cyst present?

A

virilization
altered menstruation
post-menopausal bleeding

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5
Q

how is ovarian cyst investigated?

A

TVUSS
CA125 in all post menopausal women
other basic: pregnancy, inc WCC in infection/torsion,
low Hb if bleed

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6
Q

how is ovarian cyst managed?

A

conservative or surgical - cystectomy if wants kids

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7
Q

surgical mgmt of cyst?

A

bilateral oophorectomy or cystectomy if wants kids

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8
Q

what is the most common type of ovarian cancer?

A

cystadenocarcinoma (serous/mucinous)

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9
Q

what are the symptoms of ovarian cancer?

A 
abdo pain + distension
bloating
- new IBS in pts over 50
nausea
early satiety
weight loss
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10
Q

what are the signs of ovarian cancer?

A

palpable pelvic mass

tender adnexae

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11
Q

what are symptoms of metastatic ovarian cancer?

A 
back pain
ascites
right pleural effusion
torsion/rupture
DVT
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12
Q

what are the environmental risk factors for ovarian cancer?

A

oestrogen exposure:

early menarche
late menopause
HRT
nulliparity
obesity

smoking

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13
Q

what are the genetic risk factors for ovarian cancer?

A

fam hx
BRCA1/2
HNPCC

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14
Q

what reduces the risk of ovarian cancer?

A

breastfeeding
COCP
many pregnancies

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15
Q

how is ovarian ca investigated?

A

TVUSS
Serum CA-125 >30 suggestive
RMI

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16
Q

what does raised ALP suggest in a patient with Ov Ca?

A

liver mets

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17
Q

how is ovarian cancer diagnosed?

A
  • histologically during surgery

- no needle biopsy as risk spreading

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18
Q

what is figo staging for Ov Ca?

A
  1. ovaries only
  2. pelvis
  3. early mets - superficial mets
  4. distant mets - liver parenchyma
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19
Q

how is ov ca treated?

A

surgery then adjuvant chemo

bilateral hystero-salpingo-oophorectomy (HSO), omentectomy, appendectomy

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20
Q

what chemo is used for ov ca?

A

carboplatin + paclitaxel 6months

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21
Q

how is ov ca prevented?

A

prophylactic surgery in brca1/2, high risk pts

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22
Q

which lymph nodes for ovarian cancer?

A

paraortic

inguinal/femoral suggest other gynae cancer

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23
Q

what is Pseudomyxoma peritonei

A

mucinous cystadenoma rupture in ov ca - mucin in peritoneum

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24
Q

does being brca positive give you better prognosis if ov ca?

A

yes

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25
Q

how does ovarian torsion present?

A 
adnexal mass
nausea/vomiting
severe pelvic pain
fever
abnormal bleeding
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26
Q

how is ovarian torsion diagnosed?

A

TVUS

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27
Q

what is lichen sclerosus?

A

chronic inflammatory skin disease in anogenital region

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28
Q

what can lichen sclerosus become?

A

can progress to squamous cell carcinoma

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29
Q

how is lichen sclerosus treated?

A

steroids topical

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30
Q

what are the risk factors for endometriosis

A 
early menarche
fam hx
short menstrual cycles
long/heavy periods
defects in uterus/fallopian tubes
31
Q

symptoms of endometriosis?

A 
cyclical pelvic pain
dysmenorrhoea
dyspareunia
menorrhagia 
subfertility
dyschezia (pain defecating)
32
Q

what is the main dd for endometriosis?

A

PID, similar symptoms, subacute onset

33
Q

what is gold standard diagnostic procedure for endometriosis?

A

laparoscopy

34
Q

what are typical findings on laparoscopy in endometriosis?

A

chocolate cysts
adhesions
peritoneal cysts

35
Q

what is the treatment for endometriosis?

A
  • NSAIDS
  • COCP/Mirena to prevent ovulation and cause atrophy of lesions
  • surgery
  • hysterectomy and HRT
36
Q

what is the benefit of using mirena over cocp in endometriosis?

A

lower dose of hormone?

37
Q

aside from laparoscopy how is endometriosis investigated>

A

bimanual exam

  • fixed retroverted uterus
  • uterosacral ligament nodules
38
Q

what is adenomyosis?

A

presence of endometrial tissue in the myometrium

39
Q

how does adenomyosis present?

A

dysmenorrhoea
menorrhagia
deep dyspareunia
irregular bleeding

40
Q

what can cause adenomyosis?

A

myometrium coming in contact with endometrium:

  • pregnancy and childbirth
  • c-section
  • uterine surgery
  • surgical management of miscarriage/termination
41
Q

how is adenomyosis diagnosed?

A

definitive - histological post-hysterectomy

clinically: tvus

42
Q

how is adenomyosis managed?

A

definitive - hysterectomy
symptom: NSAIDs,
hormone therapy for reduction of bleeding/cycle control

uterine artery embolisation for those wanting kids

43
Q

what hormonal therapies for adenomyosis?

A

COCP
progestogens - mirena
GnRH
aromatase inhibitors

44
Q

what is the aetiology of PCOS?

A

elevated LH - stimulates androgen production

insulin resistance

45
Q

where is LH produced?

A

anterior pituitary

46
Q

what are the risk factors for PCOS?

A

diabetes
fam hx
irregular periods

47
Q

which criteria is used for diagnosing PCOS?

A

rotterdam, 2/3 minimum for diagnosis

48
Q

what is the rotterdam criteria?

A
  1. oligo/anovulation
  2. clinical/biochemical signs of hyperandrogenism
  3. polycystic ovaries on imaging
49
Q

what blood tests for PCOS?

A
  1. LH (high)
  2. FSH (normal)
  3. Sex-hormone binding globulin (SHBG) (Low)
  4. Testosterone (high)
  5. Progesterone (low)
50
Q

what will FSH levels be like in PCOS?

A

normal!

51
Q

what will shbg levels be like in pcos?

A

low

52
Q

what will progesterone be like in pcos?

A

low

53
Q

which levels will be high in PCOS?

A

LH and testosterone only

54
Q

how do you prevent endometrial hyperplasia in PCOS?

A

inducing at least 3 bleeds per year

  • COCP
  • Dydrogesterone
55
Q

how is pcos managed?

A

lifestyle - lose weight

56
Q

how is subfertility in PCOS managed?

A

clomifene/metformin

women with low BMI may have laparoscopic ovarian drilling.

57
Q

what are the risks associated with clomifene

A 
risk of multiple pregnancies
ovarian hyperstimulation syndrome
ovarian cancer (limited for 6 cycles)
58
Q

with what is hirsutism treated?

A

antiandrogens:
cyproterone
spironolactone
finasteride

Eflornithine topical cream for facial hair

59
Q

what type of amenorrhoea is caused by turner syndrome?

A

1 X chromosome

  • primary amenorrhoea
60
Q

what are the characteristic features of turner syndrome?

A

short stature
webbed neck
broad chest
wide carrying angle (cubitus valgus)

61
Q

what do the ovaries look like in turner syndrome?

A

underdeveloped streak ovaries

62
Q

what do the kidneys look like in turner’s?

A

horseshoe

63
Q

how do you induce puberty in turner’s?

A

HRT

64
Q

Name 3 congenital heart problems that are often associated with Turner syndrome.

A
  1. coarctation of aorta
  2. aortic stenosis
  3. aortic dissection
65
Q

what is tanner stage 1?

A

pre-pubertal

66
Q

what is tanner stage 2?

A

breast buds form, few long hairs at labia

67
Q

what is tanner stage 3?

A

breast buds larger, pubic hair continues, mainly central

68
Q

what is tanner stage 4?

A

breasts in mound form, pubic hair in triangle adult shape, but smaller

69
Q

what is tanner stage 5?

A

breasts fully formed, pubic hair adult

70
Q

what does fixed retroverted uterus suggest?

A

endometriosis

71
Q

what do Uterosacral nodularity and tenderness suggest?

A

endometriosis

may be accompanied by bladder symptoms

72
Q

what is the first investigation that must be done in a woman with stress incontinence?

A

urinalysis to rule out UTI/diabetes

73
Q

where to report FGM?

A

police

2020 Phase 3a (DB) (20 decks)

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