GYNAE Flashcards
Non-surgical management of prolapse
lifestyle: weight loss, smoking cessation, treat chronic cough/constipation
topical oestrogen
vaginal pessary
What are some differentials for IMB?
hormonal contraception cervical ectropion STI polyps/fibroids endometrial or cervical cancer vaginal trauma peri-menopause
Investigate IMB
STI screen
TVUSS +/- endometrial biopsy
Manage a cervical polyp
small risk of malignant transformation so remove in clinic and send to histology
What are some differentials for menorrhagia?
endocrine: HPO axis dysfunction, thyroid disease, excess oestrogen (obesity/ liver disease)
structural: fibroids or polyps
clotting disorder
PID
endometrial cancer
Investigate menorrhagia
FBC, clotting screen, TFTs
US for fibroids/polyp
+/- endometrial biopsy
Medical management of menorrhagia
- tranexamic acid
- mirena coil
- add NSAID to tranexamic acid
- COCP
What are some non-gynae causes of pelvic mass?
bowel: constipation, abscess, tumour
urological: retention, pelvic kidney
What are some gynae causes of pelvic mass?
pregnancy uterus: fibroids, endometrial cancer (rare) cervical cancer (late) ovarian cyst ectopic pregnancy if acute ovarian cancer
How is ? ovarian cancer investigated?
Ca125
TVUSS
menopause status
biopsy not done as hard to obtain
may need further imaging with MRI
Which form of HRT is given to menopausal women?
continuous
Which form of HRT is given to perimenopausal women?
cyclical
Which form of HRT is given to a woman with a uterus?
combined
Which form of HRT is given to a woman without a uterus?
oestrogen only, continuous
Manage patient on LARC with dysmenorrhoea
mefanamic acid
Manage large fibroid which is affecting fertility
myomectomy
What is the definitive management of adenomyosis?
hysterectomy
What is the most common form of endometrial malignancy?
adenocarcinoma
Manage endometrial hyperplasia
if typical use progestogens
premenopause –> IUS
atypical needs hysterectomy
What is a leiomyoma?
fibroid
benign proliferation of myometrium
What is the most common type of ovarian tumour?
serous epithelial tumour
What is the most common type of cervical cancer?
Squamous cell carcinoma (CIN is precancer)
when can vaccum aspiration abortion be carried out until?
14 weeks
If one missed pop how long should barrier contraception be used?
48hrs
Manage PID
IM ceftriaxone, oral metronidazole and doxycycline
When can ARM be carried out?
> 1cm dilation
What type of cancer is a patient with lynch syndrome at highest risk of developing?
1 endometrial
2 ovarian
How should foetal development be monitored in obese women?
growth scans not fundal height
A 28-year-old woman is attending for a repeat ultrasound scan to assess viability of a pregnancy after being diagnosed with a threatened miscarriage. In the waiting room she becomes unwell – she collapses and an ABCDE assessment reveals a patent airway, heart rate of 56, BP of 97/49, she is peripherally cold and appears sweaty and pale. You are called to help and find on arrival that oxygen and IV fluids have not made any improvement in her condition. What is the definitive treatment?
Speculum examination and removal of products of conception
–> likely cervical shock due to miscarriage has caused vagal stimulation
A 34-year-old woman complains of intermittent pain in the left iliac fossa for the past 2 months. The pain is often worse during intercourse. She also reports urinary frequency and feeling bloated. There is no dysuria or change in her menstrual bleeding. What is the most likely diagnosis?
ovarian cyst
What condition are woman with PCOS at increased risk of?
ovarian torsion
How long after unprotected sex can an IUD be inserted?
5 days
Investigate sub-fertility with ? problem of tubal patency due to PID
laparoscopy
What age group are fibroids seen?
pre-menopausal
fed by oestrogen
A cyst of what size should be offered surgery?
> 7cm due to risk of ovarian torsion
Are postmenopausal cysts normal?
always abnormal
calculate rmi
US features x menopausal status x Ca125
How is a postmenopausal cyst with
a) low risk
b) high risk
managed?
a) if simple repeat US in 3 months
if not simple ?surgery
b) gyn onc MDT, CT chest abdo pelvis
A 34 year old nulliparous woman has chronic pelvic pain.Bimanual examination of the pelvis reveals a fixed retroverted uterus, with tender nodules on the uterosacral ligaments.
Which is the most likely diagnosis? A. Adenomyosis B. Endometriosis C. Inflammatory bowel disease D. Ovarian carcinoma E. Pelvic inflammatory disease
B endometriosis
A 29 year old woman visits her GP with a heavy sensation in her vagina when exercising. She is aware of a bulge in her vagina, sometimes associated with a desire to void urine. She had a vaginal delivery 2 years ago.There is some laxity of the anterior vaginal wall, but this does not descend to the introitus on straining. Urine culture is negative.
Which is the most appropriate management plan? A. Oxybutinin hydrochloride B. Pelvic floor exercises C. Refer for urodynamic testing D. Refer to urogynaecology clinic E. Ultrasound scan of pelvis
B. pelvic floor exercises
