Gynae 1 Flashcards
1
Q
Describe the most common risk factor for uterine fibroids (leiomyomas)
A
Race, specifically Black race
2
Q
What is the most common site for uterine fibroids (leiomyomas)?
A
Intramural
3
Q
What is the most common symptom of uterine fibroids (leiomyomas)?
A
Bleeding
4
Q
What complications are associated with the submucosal type of uterine fibroids (leiomyomas)?
A
Infertility and recurrent abortion
5
Q
What complication is associated with the subserosal type of uterine fibroids (leiomyomas)?
A
Torsion
6
Q
How is severe pain during pregnancy in uterine fibroids (leiomyomas) managed?
A
Ischemic necrosis is an important complication
7
Q
Define the impact of estrogen levels on uterine fibroids (leiomyomas) prognosis
A
Mainly affected by estrogen levels, rare before puberty, and degenerates after menopause
8
Q
What is the recommended treatment for young females with uterine fibroids (leiomyomas) who still want children?
A
Myomectomy
9
Q
Describe the treatment approach for uterine fibroids (leiomyomas) in older patients who do not want children
A
Hysterectomy
10
Q
What is the significance of red degeneration in fibroids?
A
Associated with timing during pregnancy, presenting with abdominal pain and fever
11
Q
How is primary dysmenorrhea managed in young females?
A
First line treatment with NSAIDs, second line with OCPs
12
Q
Describe the most common site of endometriosis
A
Ovary, often presenting as a chocolate cyst
13
Q
What are the common symptoms of endometriosis in young patients?
A
Infertility, dysmenorrhea, dyspareunia, dyschezia
14
Q
What is the investigation of choice for endometriosis?
A
Laparoscopy
15
Q
How is endometriosis treated in young patients?
A
Not Encourage pregnancy bad racgp myth
Empirical treatments include simple analgesics, nonsteroidal anti-inflammatory drugs (NSAIDS), progesterones, and the combined oral contraceptive pill (COCP), as well as exercise, nutrition and multiple alternate therapies.
Endometriosis can occur in teenagers. In the presence of ongoing symptoms not responding to the OCP or continuous OCP (where several periods are missed by skipping the sugar pills), then careful pelvic ultrasound and consideration of laparoscopy may be appropriate. Care needs to be taken with making this diagnosis, as a negative outlook on pelvic pain and future fertility may be established. Other causes of pelvic pain, and factors that may contribute to pain such as stresses and past physical and sexual abuse need to be considered. racgp
16
Q
What are the side effects of danazol in endometriosis treatment?
A
Menopausal symptoms like acne, hirsutism, and hot flushes
17
Q
Describe the treatment for androgen insensitivity syndrome
A
Removal of testes after puberty due to defect in androgen receptors
18
Q
What are the common characteristics of Turner syndrome?
A
Short stature, low IQ, webbed neck, wide-spaced nipples, and CHD
19
Q
Describe the clinical presentation of congenital adrenal hyperplasia in infants.
A
Infants with congenital adrenal hyperplasia may present with weight loss, vomiting, dehydration, salt-losing features like hyponatremia, hyperkalemia, and hypoglycemia. Female infants may have masculinized external genitalia.
20
Q
What is the most common cause of hirsutism in idiopathic hirsutism?
A
Idiopathic hirsutism is most commonly caused by spironolactone.
21
Q
Define primary amenorrhea in the context of Kallman syndrome.
A
Primary amenorrhea in Kallman syndrome is characterized by low levels of GnRH, FSH, and LH, leading to absent menstruation and anosmia.
22
Q
How is secondary amenorrhea defined, and what is the initial test recommended for diagnosis?
A
Secondary amenorrhea is the absence of menstruation for at least 3 months in women with previously normal menstrual cycles. The initial test recommended is a beta-hCG to rule out pregnancy.
23
Q
Describe the clinical features of polycystic ovarian syndrome (PCOS).
A
PCOS is characterized by irregular bleeding, obesity, acne, hirsutism, infertility, and acanthosis nigricans due to insulin resistance.
24
Q
What is the treatment approach for infertility in PCOS patients?
A
Infertility in PCOS patients can be treated with clomiphene or human menopausal gonadotropin as first-line options.
25
Explain the hormonal profile seen in PCOS.
In PCOS, androgen and testosterone levels are increased, LH levels are elevated, and the LH:FSH ratio is reversed (greater than 2).
26
Describe the management of hypothalamic pituitary failure.
Hypothalamic pituitary failure can be managed with pulsatile GnRH therapy.
The management of hypothalamic-pituitary failure (hypopituitarism) involves:
1. **Hormone Replacement**:
- **Corticosteroids** (e.g., hydrocortisone) for adrenal insufficiency.
- **Levothyroxine** for thyroid hormone deficiency.
- **Sex Hormones** (testosterone for males, estrogen/progesterone for females).
- **Growth Hormone** if needed.
- **Desmopressin** for diabetes insipidus.
2. **Monitoring and Follow-up**:
- Regular hormone level checks.
- Adjust doses during stress or illness.
3. **Address Underlying Cause**:
- Treat tumors, infections, or inflammatory conditions if present.
4. **Patient Education**:
- Teach about lifelong hormone therapy and emergency hydrocortisone use.
For more detailed guidelines, refer to the RACGP and the Australian Endocrine Society guidelines.
27
What is the most common malignancy associated with premature ovarian failure?
Endometrial cancer is the most common malignancy associated with premature ovarian failure.
### Premature Ovarian Insufficiency and Associated Malignancies
Premature ovarian insufficiency (POI) can be associated with various malignancies, with ovarian cancer being a primary concern due to the common iatrogenic causes such as chemotherapy and radiotherapy. Additionally, the hormonal imbalances associated with POI can influence the risk of endometrial cancer.
#### Key Points:
1. **Ovarian Cancer**:
- **Risk Factors**: Chemotherapy and radiotherapy for other cancers can increase the risk of ovarian cancer in women with POI.
- **Management**: Regular screening and follow-up are recommended for early detection.
2. **Endometrial Cancer**:
- **Hormonal Imbalance**: Women with POI may have altered levels of estrogen and progesterone, which can affect the endometrial lining.
- **Hormone Replacement Therapy (HRT)**: Proper use of HRT can help manage symptoms and reduce the risk of endometrial hyperplasia and cancer. It is crucial to tailor HRT to balance benefits and risks.
- **Monitoring**: Women on HRT should have regular follow-ups to monitor the health of the endometrium.
#### Management Recommendations:
1. **Regular Screening**: Women with POI, especially those on HRT, should undergo regular gynecological evaluations to monitor for signs of malignancy.
2. **Individualized HRT**: HRT should be customized based on individual risk factors and needs, ensuring a combination of estrogen and progesterone if the uterus is intact.
3. **Lifestyle Modifications**: Encouraging a healthy lifestyle, including a balanced diet and regular exercise, to support overall health and reduce cancer risks.
For more detailed guidelines, refer to the RACGP resources on managing premature ovarian insufficiency and associated malignancies:
- [RACGP - Premature Ovarian Insufficiency and Infertility](https://www1.racgp.org.au/clinical-resources/clinical-guidelines/view-all-clinical-guidelines/sexually-transmissible-infections/management/contact-tracing)
- [RACGP - Meeting the Needs of Women with Premature Ovarian Insufficiency](https://www1.racgp.org.au/clinical-resources/clinical-guidelines/view-all-clinical-guidelines/sexually-transmissible-infections/management/contact-tracing)
These resources provide comprehensive information on the diagnosis, management, and long-term care of women with POI.
28
How is congenital adrenal hyperplasia typically treated?
Congenital adrenal hyperplasia is usually treated with cortisone.
1. Glucocorticoid Replacement: Hydrocortisone is commonly used in children to replace cortisol, while prednisone or dexamethasone may be used in adults. The objective is to use the lowest effective dose to avoid long-term side effects while suppressing excess androgen production.
2. Mineralocorticoid Replacement: For salt-wasting forms of CAH, fludrocortisone is administered to replace aldosterone, which helps maintain sodium balance and prevent dehydration.
Congenital adrenal hyperplasia (CAH) is a group of genetic disorders that affect the adrenal glands, which are responsible for producing vital hormones like cortisol, aldosterone, and androgens. The most common form of CAH is due to a deficiency of the enzyme 21-hydroxylase, which is crucial for the synthesis of cortisol and aldosterone.
### Key Features of CAH:
1. **Hormonal Imbalances**: Due to the enzyme deficiency, there is a buildup of precursor molecules that are shunted into the androgen production pathway, leading to an excess of androgens (male hormones). This hormonal imbalance can cause various symptoms depending on the severity of the enzyme deficiency.
2. **Cortisol Deficiency**: Cortisol is essential for stress response, blood sugar regulation, and immune function. A deficiency can lead to poor stress tolerance, hypoglycemia, and increased susceptibility to infections.
3. **Aldosterone Deficiency**: Aldosterone helps regulate sodium and potassium levels and maintain blood pressure. Its deficiency can lead to salt-wasting, dehydration, low blood pressure, and hyperkalemia (high potassium levels).
4. **Androgen Excess**: Increased androgen levels can cause virilization (development of male physical characteristics) in females, such as ambiguous genitalia at birth, and early puberty in both boys and girls. In females, this can lead to hirsutism (excessive hair growth) and menstrual irregularities later in life.
### Symptoms:
- **Newborns**: Ambiguous genitalia in females, poor feeding, vomiting, dehydration, and failure to thrive in both genders.
- **Children**: Rapid growth and early development of secondary sexual characteristics (precocious puberty).
- **Adults**: Fertility issues, irregular menstruation in females, and potential psychological impacts due to physical changes.
### Diagnosis:
- **Newborn Screening**: Most cases of CAH are identified through routine newborn screening tests that measure 17-hydroxyprogesterone levels, a precursor that accumulates due to 21-hydroxylase deficiency.
- **Hormonal Tests**: Confirmatory tests include measuring levels of cortisol, aldosterone, and androgens.
- **Genetic Testing**: Genetic analysis can identify mutations in the genes responsible for CAH.
### Treatment:
- **Hormone Replacement Therapy**: Lifelong glucocorticoid (e.g., hydrocortisone) and, if necessary, mineralocorticoid (e.g., fludrocortisone) replacement to manage cortisol and aldosterone deficiencies.
- **Monitoring**: Regular follow-ups to adjust medication dosages and monitor growth and development.
- **Surgery**: In some cases, reconstructive surgery may be necessary to correct ambiguous genitalia.
- **Psychological Support**: Counseling and support for patients and families to address the psychosocial aspects of the condition.
### Sources:
- [RACGP - Adrenal Disease Update](https://www1.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/adrenal-disease)
- [RACGP - Disorders of Sex Development in Children and Adolescents](https://www1.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/sex-development-disorders)
29
Explain the genetic inheritance pattern of congenital adrenal hyperplasia.
Congenital adrenal hyperplasia is typically inherited in an autosomal recessive pattern.
30
What are the causes of secondary amenorrhea other than pregnancy?
Causes of secondary amenorrhea include obesity leading to polycystic ovaries, excessive exercise, low body fat, emotional distress, hyperprolactinemia, brain tumors, chemotherapy drugs, antipsychotic medications, hyperthyroidism, and reduced ovarian function.
31
Describe the clinical features of congenital lymphedema.
Congenital lymphedema presents with swelling due to abnormal lymphatic drainage present at birth.
32
How is congenital lymphedema managed?
Congenital lymphedema is managed with compression garments and physical therapy.
33
Explain the hormonal changes seen in premature ovarian failure.
Premature ovarian failure is characterized by increased FSH levels.
34
What is the recommended treatment for premature ovarian failure?
Premature ovarian failure can be treated with estrogen and progesterone replacement therapy after puberty.
35
What is the treatment for bacterial vaginosis during pregnancy?
Metronidazole
36
Describe the clinical picture of bacterial vaginosis.
Thin, grayish-white discharge with a fishy odor
37
How is bacterial vaginosis diagnosed microscopically?
Clue cells
38
Define lichen sclerosus.
A condition typically affecting postmenopausal women, characterized by itching in the ano-genital area
39
What is the first step in diagnosing lichen sclerosus?
Punch biopsy
40
Do you need to treat the partner for candida infection?
No
41
Describe the vaginal discharge in candida infection.
Thick, scanty, cheesy, and odorless
42
What is the drug of choice for candida infection?
Oral fluconazole
43
How is candida infection diagnosed microscopically?
Pseudohyphae
44
Describe the treatment approach for patients who are positive for Chlamydia and gonorrhea.
Patients should be treated with ceftriaxone and azithromycin.
45
What should be done if a patient treated for Chlamydia returns with the same symptoms?
Test for gonorrhea.
46
How should partners of patients with Chlamydia be managed?
Partners should be traced, tested, and treated against Chlamydia.
47
Define the screening recommendations for Chlamydia.
All sexually active females aged 15–29 years should be screened annually to prevent infertility.
48
How is opportunistic screening for Chlamydia typically conducted?
PCR testing on first catch urine is commonly used.
49
What are the risk factors for cervical neoplasia?
Risk factors include HPV infection (types 16, 18, 31, 33, 35), early sexual activity, multiple partners, prostitution, and smoking.
50
Describe the management of Cervical Intraepithelial Neoplasia (CIN) 3.
CIN 3 should be followed by colposcopy and biopsy.
51
How is vaccination against HPV typically administered?
The Gardasil vaccine is used to protect against HPV types 6, 11, 16, and 18.
52
What is the recommended frequency for Pap smear screening?
Every 2 years for women aged 18-20 years or 2 years after first sexual activity, up to the age of 70 if previous tests were normal or after a hysterectomy.
53
Do lesbian females need cervical cancer screening?
Yes, lesbian females should undergo cervical cancer screening.
54
Should virgin females undergo cervical cancer screening?
No, virgin females do not require cervical cancer screening.
55
Describe the age and gender criteria for HPV vaccination based on the content.
Females aged 9-45 and males aged 9-26 are eligible for HPV vaccination.
56
Do sexually active females benefit from receiving the HPV vaccine according to the content?
Yes, sexually active females can still receive the HPV vaccine.
57
Define the maximum benefit of receiving the HPV vaccine as per the content.
The vaccine is most beneficial when administered before starting sexual activity.
58
How should females with previous genital warts approach HPV vaccination based on the content?
They are encouraged to receive the HPV vaccine.
59
Describe the recommendation for pregnant females regarding HPV vaccination according to the content.
Pregnant females should not receive the HPV vaccine.
60
Define the approach towards HPV vaccination for immunocompromised females according to the content.
Immunocompromised females are advised against receiving the HPV vaccine.
61
How is serology for HPV typically viewed based on the content?
Serology for HPV is generally not recommended.
62
Describe the common side effects associated with Diethylstilbestrol (DES) as mentioned in the content.
Side effects include T-shaped uterus, cervical insufficiency, sarcoma botryoides, and endometrial cancer.
63
How is endometrial cancer characterized in terms of age and common risk factors according to the content?
Endometrial cancer is most common around the age of 60 and is often linked to risk factors like unopposed estrogen, obesity, hypertension, diabetes, nulliparity, late menopause, PCOS, chronic anovulation.
64
Define the primary investigative methods for endometrial cancer as per the content.
Investigations typically involve transvaginal ultrasound, hysteroscopy, and biopsy.
65
How is postmenopausal bleeding viewed in relation to endometrial cancer until proven otherwise based on the content?
Postmenopausal bleeding is considered cancer of the endometrium until proven otherwise.
66
Describe the risk factors associated with ovarian cancer according to the content.
Risk factors include age, low parity, infertility, delayed childbearing, family history, BRCA1 and BRCA2 mutations, Lynch II syndrome.
67
Do tumor markers like CA-125 play a role in the diagnosis of ovarian cancer as mentioned in the content?
Yes, tumor markers like CA-125 are often elevated in ovarian cancer and can aid in diagnosis.
68
Define the primary treatment approach for ovarian cancer according to the content.
The main treatment for ovarian cancer is debulking surgery.
69
How is pelvic organ prolapse diagnosed and treated based on the content?
Diagnosis involves history and physical exam, with treatment options including weight reduction, kegel exercises, pessaries, and surgical procedures like hysterectomy.
70
Describe the characteristics of total incontinence according to the content.
Total incontinence involves uncontrolled loss of urine at all times and in all positions, often caused by factors like fistula, previous surgery, nerve damage, or cancer.
71
How is stress incontinence defined in the content?
Stress incontinence is the most common type, triggered by increased intra-abdominal pressure like coughing or sneezing, often seen in multiparous women or after pelvic surgery.
72
Describe the management of functional ovarian cysts less than 6 cm in size.
Rescan after 6-8 weeks and consider giving oral contraceptive pills.
73
Define detrusor hyperreflexia (urge incontinence).
It is characterized by a strong, unexpected urge to void that is unrelated to position.
74
How is pelvic inflammatory disease diagnosed?
Diagnosis involves a clinical picture of mucopurulent cervical discharge, severe lower abdominal pain, tenderness, fever, nausea, and vomiting. Examination may reveal tenderness, guarding, and cervical motion tenderness.
75
What is the main ligament supporting the uterus?
The uterosacral ligament.
76
Describe the treatment for Bartholin cysts.
For small cysts, observation is recommended. Larger or symptomatic cysts may require marsupialization. Abscesses may need antibiotics, drainage, and catheter placement.
77
What are the risk factors for pelvic inflammatory disease?
Risk factors include multiple sexual partners and the presence of an intrauterine device (IUD).
78
Do Kegel exercises help with urinary incontinence?
Yes, Kegel exercises can be beneficial for improving pelvic floor muscle strength and controlling urinary incontinence.
79
Define overflow incontinence.
It is characterized by chronic urinary retention and a chronically distended bladder, leading to dribbling of urine due to intravesical pressure exceeding outlet resistance.
80
How is urge incontinence (detrusor hyperreflexia) commonly treated initially?
Bladder training is the first-line treatment for urge incontinence.
81
Describe the treatment for pelvic inflammatory disease.
Treatment may involve removing any intrauterine device (IUD), hospital admission, and antibiotic therapy such as ceftriaxone and doxycycline or gentamicin.
82
Describe the presentation of Toxic Shock Syndrome (TSS) if ruptured due to S. aureus toxin (TSST-1) from tampons.
Abrupt onset of fever, vomiting, watery diarrhea, diffuse macular erythematous rash, desquamation (especially of the palms and soles).
83
Define precocious puberty and differentiate between central and peripheral precocious puberty.
Precocious puberty is the early development of secondary sexual characteristics. Central precocious puberty results from early activation of hypothalamic GnRH production, while peripheral precocious puberty is caused by nonhypothalamic GnRH production.
84
How is premature thelarche characterized in girls under 3 years of age?
Premature thelarche is breast development in girls under 3 years caused by maternal estrogens, with no other signs of puberty and normal growth with appropriate bone age.
85
What is the most important question to ask a female with delayed menstruation?
Timing of breast budding, as menstruation usually occurs 2 years after breast budding.
86
Describe the diagnostic steps for precocious puberty.
First step: Obtain a wrist and hand x-ray to determine bone age. Next step: Conduct a GnRH agonist stimulation test. For central precocious puberty, if LH response is positive, obtain a cranial MRI. For peripheral precocious puberty, if LH response is negative, order ultrasounds and hormone tests.
87
What is the treatment for central precocious puberty?
Leuprolide is the first-line treatment for central precocious puberty.
88
How is premature thelarche managed?
Premature thelarche is managed by reassurance as it is often benign and resolves on its own.
89
Define normal stages of puberty in females.
Normal stages of puberty in females include breast development (Thelarche), pubic hair growth (Pubarche), increase in growth velocity, and menstruation (Menarche).
