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Medicine > Gynae > Flashcards

Gynae Flashcards

1
Q

Follicular Stage ~ 14 days

Hormone Changes

A

FSH:​ Stim Follicles -> second Follicles (surrounded by Granulosa cells)​

(Granulosa cells release Oestrogen: => Decrease in GnRH/FSH/LH)​

LH:​ Surge (Past certain point Oestrog (+) feedbacks)
=> Release of Ovum​

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2
Q

Luteal Stage = 14 day
Hormone changes
If Ovum Fertilised/Non-Fert

A

Empty Follicle - > Corpus Luteum (Prod Oestrog + Prog)​

If ovum fertilised:​
-> Embryo (produces hCG -> maintains Corpus Luteum)​

If ovum not fertilised:​ (Degeneration of corpus Luteum):
Reduced Oestrog + Prog -> Increased GnRH (+FSH/LH)​
Breakdown of endometrium (-> Menstruation) ​

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3
Q

Menstrual Cycle Stages + Def

A

Follicular Stage:
Maturation of Follicle

Luteal Stage:
Movement of Follicle/Ovum +/- Menstruation

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4
Q

Hypogonadotropic/Hypergonadotropic Prim Amenorrhoea causes​

A

Hypogonadotropic: (Loss of LH/FSH)​
Damage to hypothalamus/ant Pit​, Hypo-Pit​
Chronic condition (CF, IBD)​
Excessive exercise/diet​

Hypergonadotropic: (Lack of Resp to LH/FSH)​
Damage to Gonads (Torsion, cancer, Inf)​, Congen Absence of Ovaries​
Turners Synd (45, XO – Growth Def in girls)​
CAH (21-Hydroxylase Def => Overproduct of Androgens)
AIS (Fail to Resp to Test => No descent of Testis)

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5
Q

Sx of Structural Causes of Prim Amenorrhoea

A

No Menses => Cyclical Abdo pain
Abnormal Genitalia/Pelvic Organs
(Normal Second sex Charact: Hair, Breasts, Growth)

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6
Q

Primary Amenorrhoea Ix - 7

A

Invest:​
bhCG - Pregnancy test
FBC (+ Fe) – Anaemia
U+Es – CKD
Anti-ttG – Coeliac D
TFTs, PRL – Prolactinoma (+/- MRI), LH/FSH, IGF-1 – GH Def​
Testosterone – Raised w/: PCOS, CAH, AIS​
Physical Ex/USS (If abnormal: Karyotype)​
(X-ray Bone age – Develop delay)​

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7
Q

Prim Amenorrhoea​ Mx
Conservative
Hypogonadotropic
Hypergonadotropic

A

Conservative:​
Wait, Reduce Stress, Increase BMI​, CBT

Hypogonadotropic:​
Pulsatile GnRH (Restores menses, no contraception)​
COCP (Restores menses w/ contraception)​

Hypergonadotropic:
COCP​

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8
Q

Second Amenorrhoea Def + causes​ - 5

A

Cessation of Reg menses > 3 months or Irreg menses > 6 months​

Pregnancy​, Menopause, Premature Ovarian Fail​, Hormonal contraception​
Prolactinoma (Hyper-PRL => Panhypo-Pit + Hypogonadotropic hypogonadism)​
Thyroid D​ (HypoTh)
PCOS
Stress ​(Low BMI/Excessive Exercise, Chronic cond -> Reduced GnRH)​

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9
Q

Second amenorrhoea Ix - 6

A

bhCG (Pregnancy test)​
LH/FSH (Raised LH: PCOS, Raised FSH: Prim Ovarian Fail)​
Testosterone (Raised w/: PCOS, CAH, AIS)​
PRL (Prolactinoma), MRI (Pit adenoma)​
TFTs​
Pelvic USS​

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10
Q

PMS Diagnosis + Timing Rules

A

Cyclical Sx spanning > 2 cycles​
(If Sx severe: Premenstrual Dysphoric Disorder)​

Timing:
Sx not present before menarche, during pregnancy, after menopause​
Can occur in response to HRT/COCP​
Can occur after surgery/hysterectomy (Ovaries cont to function)​

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11
Q

Menorrhagia Mx:
Contra not Req
Contra Req

A

Contraception not required:
No pain: Tranexamic Acid
Pain: Mefenamic Acid

Contraception required: 
Mirena Coil (IUS) 
COCP 
POP 
(Referral for Endometrial Ablation, Hysterectomy)
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12
Q

Fibrioids Def

A

Benign, Oestrog-Sens, SM Tumours – Leiomyomas

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13
Q

Fibrioids Mx:
Contra not Req
Contra Req

A

Contraception not required:
No pain: Tranexamic Acid
Pain: Mefenamic Acid

Contraception required:
Mirena Coil (IUS)
COCP
POP

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14
Q

Fibrioids Mx: Surg

A

Surg: (GnRH Agonist => Reduce Fibroid size):
Small (< 3cm): Endometrial Ablation, Resection, Hysterectomy
Large (> 3cm): Uterine A Embolization, Myomectomy, Hysterectomy

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15
Q

Endometriosis + Adenomyosis Def

A

Ectopic Endometrium,

Adenomyosis: Ectopic Endometrium w/in Myometrium

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16
Q

Endometriosis Mx

A

HRT (Sx control):
COCP, POP, Prog Inj, Prog Implant, IUS
GnRH Agonists (Induce Menopause)

Surg (Increase Fertility):
Lap (+/- Biopsy, Ablate/Excise, Remove Adhesions)
Hysterectomy + Bilat Salpingoopherectomy

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17
Q

Adenomyosis Mx:
Contra not Req
Contra Req
Surg

A

Contraception not required:
No pain: Tranexamic Acid
Pain: Mefenamic Acid

Contraception required: 
Mirena Coil (IUS) 
COCP 
POP 
Surg: Endometrial Ablation, Uterine A Embolization, Hysterectomy
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18
Q

Fibrioids vs Endometriosis vs Adenomyosis

A

Fibrioids: Cyclical pain, Menorrhagia, Enlarged/Firm/Tender Uterus
Endometriosis: Cyclical/Chronic (Cont) pain, Menorrhagia
Adenomyosis: Pain, Menorrhagia, Enlarged/Tender Uterus

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19
Q

Menorrhagia Ix

A 
Pelvic/Abdo Ex (Fibroids, Ascites, Cancer)​
FBC + Fe (Anaemia)​
Hysteroscopy​
Pelvic/Trans-vag USS​
Lap +/- Biopsy (Endometriosis)
Hysterectomy w/ Histology (Adenomyosis)
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20
Q

Menopause Def

Premature Menopause Def + Criteria

A

Menopause: Permanent end to Menses (> 12 months)

Premature: Ovarian Fail/Insuff (Menopause < 40yo)

Women < 40yo w/ typical menopausal Sx + Raised FSH

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21
Q

Premature Menopause Mx:
w/w/out Uterus
w/w/out Menses
Supp

A

HRT until Menopause Age: 50:
w/ Uterus: Oestrog + Prog (Req for Endometrial Protection)
(COCP not recommended; increased VTE risk)​
w/out Uterus: Oestrogen-only HRT (Patch)

w/ Menses: Cyclical w/ Reg Breakthrough bleeds
w/out Menses: Continuous HRT

Vag Lubricants, Oestrogen pessaries/gel​
CBT, SSRi, Mood stabilisers​
(Testosterone => Increase Libido)​

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22
Q

Premature Menopause Patho + Sx

A

Reduced Ovarian follicles -> Reduced Oestrogen =>​
Increase in FSH/LH​ =>

Anovulation/Amenorrhea/Irreg menses
Perimenopausal Sx​
​

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23
Q

PCOS Criteria

A

Oligoovulation/Anovulation​
Hyperandrogenism (Hirsuitism, Acne, Weight Gain)
Polycystic ovaries on USS​ (String of pearls: > 12, Ovarian Vol > 10cm3)
(+/- Infertility, Insulin-resistance)​

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24
Q

PCOS Ix

A

Hormone assay:​
Increased: Testosterone (excess androgens), LH/FSH, Insulin​
PRL (Hypopituitarism), TFTs (HypoTh)​

Pelvic/Transvag USS:​
Ovarian Vol > 10cm3​
> 12 developing follicles on an ovary (string of pearls around Periph)​

OGTT (screen for DM):​
Glu > 11mmol 2hrs after drink (Impaired tolerance)​

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25
Q

PCOS Mx

A

Weight loss, Statins, Orlistat (Lipase Inhib: Reduce Absorption of fat w/in Intestines)

Mirena Coil (oppose Oestrogen)

COCP (Dianette: Anti-androgenic Effects)

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26
Q

Ovarian Cysts Ix

A

Pelvic USS:
If simple: < 5cm: No f/up Req,
If Complex: > 5cm: Tumour Markers

Tumour Markers: aFP, LDH, hCG, CA-125

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27
Q

Meigs Synd

A

Ovarian Fibroma (Benign), Pleural Effusion, Ascites

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28
Q

Ovarian signs on USS:
Ruptured Cyst
Torsion

A

Ruptured Cyst: Free fluid w/in Peritoneum

Torsion: Free fluid w/in Peritoneum, Whirlpool Sign, Ovarian Oedema

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29
Q

Ashermans Syndrome Def + Sx​

A

Adhesions w/in Uterus (Inf, Trauma, Surg)​

Sx:​
Lighter periods, Second Amenorrhea
Dysmenorrhea​
(Infertility, Recurrent miscarriages)​

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30
Q

Ashermans Syndrome Invest + Mx​

A 
Invest:​
Hysteroscopy (w/ Dissection)​
Hysterosalpingography (X-ray w/ contrast)​
Sonohysterography (Pelvic USS w/ Fl)​
MRI​

Mx:​
Dissection during hysteroscopy​

31
Q

Incontinence Ix

A 
Ex:​ (Pelvic tone​, Cough Impulse​)
Bladder diary​
Urin dipstick​
Post-void Bladder scan​
Urodynamic tests​
32
Q

Incontinence Mx (Conservative)

A

Lifestyle changes:
Reduce Caffeine/Alcohol
Reduce BMI
Stop Meds (Diuretics)

33
Q

Stress Incontinence Mx

A

Pelvic floor exercises​
Surg (mesh, stitches, bulking)​
Duloxetine (SNRi AntiD)​

34
Q

Urge Incontinence Mx

A

Bladder retraining (Increase time btw voids)​
Anti-cholinergics (Oxybutynin)​
Mirabegron (Beta3 Agonist)​

35
Q

COCP UKMEC4 - 7

A 
Uncontrolled HT, IHD/AF/Cardiomyopathy 
Vasc D/Stroke, Hx of VTE
Migraine w/ Aura
Age > 35 + Smoking > 15/day
Maj Surg w/ prolonged Immobility
Liver Cirrhosis/Tumours
SLE, Anti-phospholipid Synd
36
Q

Rules governing contra for Adolescents

A

Refer to Fraser guidelines and ensure patient is gilick competent:​

Understands advice​
Encouraged to involve parents​
(-) physical/mental effect if advice/treatment withheld​
Action is in best interests​

37
Q

Methods of Postpartum Contra

A

Emergency contraception only needed past 21 days

1): Lactational amenorrhoea:​
Anovulation since delivery​,
Fully breastfeeding​,
Infant < 6 months​

2) : POP/implant (safe whilst breastfeeding)​
3) : COCP (Avoid while breastfeeding, UKMEC2 after 6wks)​
4) : IUD/IUS (Inserted w/in 48hrs or > 4wks – otherwise expulsion likely)​

38
Q

IUD/IUS lost threads Invest​, Timing

A 
Pregnancy test​
Exploration w/ narrow A forceps​
USS, AXR​
Hysteroscopy, Lap surg​
​
(Excl: Expulsion, Pregnancy, Uterine perforation​)

IUD: (Lasts 5-10yrs)
IUS: (Lasts 5yrs)

39
Q

Emergency Contra

A

IUD (wait 5 days)
IUS/Mirena (w/in 72hrs)
Ulipristal Acetate (w/in 120hrs/5 days):
(Avoid Bfeeding for 1wk, Avoid in Asthma, Delay COCP/POP for 5 day)

40
Q

Missed Pill Rules

A

If miss pill/DnV => Take extra pill​
If +/- 5 days from Day 14 seek Emergency Contra
If miss multiple pills => Skip pill-free period + take extra contraception

41
Q

COCP SE:

A

Breast tenderness,
Headaches,
N+V
VTE Risk, Breast Ca Risk

42
Q

Prog SE:

A 
Breast tenderness, 
Headaches, 
N+V
Weight gain
Acne
Abnormal Bleeding (Pill: 1/3, Inj/Implant: Problematic - COCP)
43
Q

IUD/IUS SE

A

Problematic Bleeding (COCP)
Pelvic Pain
Expulsion
Increased risk of Ectopics

44
Q

Coil Contras

A

PID/STI
Pregnancy
Pelvic Ca
Uterine distortion (Fibroids)

IUD: Wilsons D
IUS: Cervical/Endometrial Ca

45
Q

HPV => Cerv Ca Patho

A

HPV 16/18 infects cervix + releases:​

E6: Inhibs p53​

E7: Inhibs pRb ​

46
Q

Cerv Screening (Smear)

A

Smear: Collection of cells tested for HPV + Cytology (Assess Dyskariosis: Pre-cancerous changes)
If 25-49: Every 3yrs
If 50-65: Every 5yrs
(If Preg: Wait 12wks)

Inadequate sample: Repeat after 3 months
HPV(-): Continue normal screening
HPV(+) w/ normal cytology: Repeat after 12 months
HPV(+) w/ abnormal cytology: Refer for Colposcopy

47
Q

Cerv Screening (Colposcopy)

A

Biopsy taken + sent for Histopathological grading of Dysplasia:

CIN 1: Mild (1/3)
CIN 2: Mod (2/3)
CIN 3: Severe (+/- => Cancer)

48
Q

Cervical Ca FIGO Staging

A

S1: Confined to cervix​

S2: Invades uterus/upper Vag​

S3: Invades Pelvic wall/lower Vag​

S4: Invades pelvic organs (Bladder, Rectum, Pelvis)​

49
Q

Cerv Ca Mx + Prevention

A

CIN, S1: LLETZ, Cone Biopsy​
S1 – 2a: Radical Hysterectomy (+ removal of L.Ns)​
S2b – 4: Surg, Radio/ChemoTx, Palliative​
(Adv cancer: Pelvic Exenteration:​
Rad Surg to Remove all pelvic organs: Vag, Cervix, Uterus, Fallopian tubes, Ovaries, Bladder, Rectum)​

Prevention: Gardasil (HPV Vaccine)

50
Q

Endometrial Hyperplasia Def, Risk F + Mx

A

Pre-cancerous condition w/ 2 types:​
Hyperplasia w/ out Atypia​
Atypical hyperplasia​

(Risk F: Unopposed oestrogen​)

Mx:​
IUS (Mirena coil)​
PO Prog​

51
Q

Endometrial Ca Referral

A

PM bleeding (> 12 months since LMP) => 2 week wait​

Unexplained Vag discharge/Visible Haematuria in women > 55yo => Trans-Vag USS​

52
Q

Endometrial Ca Ix

A

TV-USS (Nomal Endo Thickness: < 4mm)

Pipelle Biopsy (w/ Speculum)

Hysteroscopy (w/ Endometrial Biopsy)

53
Q

Endometrial Ca FIGO Staging

A

S1: Confined to Uterus

S2: Invades Cervix

S3: Invades Ovaries/Fallopian tubes/Vag/LN’s

S4: Invades other Pelvic Organs

54
Q

Endometrial Ca Mx

A

S1+2: TAH + BSO (+/- Radio/ChemoTx)

+/- Prog: Slow Cancer

55
Q

Ovarian Ca Referral

A

Ascites, Abdo/Pelvic masses: 2wk-wait

Change in bowel habit, Weight loss, Bloating, Pelvic pain, Urin Sx: CA-125

56
Q

Ovarian Ca Ix

A

(RMI: Risk of Malig Index):
Menopausal Status
USS Findings
CA-125 level (> 35 IU/ml)

(Women < 40yo w/ complex ovarian mass: (GCs): aFP, hCG )​

57
Q

Ovarian FIGO Staging

A

S1: Confined to Ovaries

S2: Spread, w/in Pelvis

S3: Spread, w/in Abdo

S4: Dist Metastasises

58
Q

Ovarian Ca Mx

A

Surg + Chemo

59
Q

Vulval Ca/VIN Risk F

A

Adv Age (> 75yo),
Immunosuppression,
HPV Inf
Lichen Sclerosus

60
Q

VIN Mx

A 
(Diagnosed via Biopsy) 
Watch+wait 
Wide Local Excision 
Imiquimod cream (Immune modulator) 
Laser Ablation
61
Q

Vulval Ca Ix + Mx

A

2wk-wait w/ Biopsy (Incl Sentinel LN’s)
(Staging CT Abdo/Pelvis)
Wide-local Excision +/- LN dissection
Chemo/RadioTx

62
Q

BV Features

A 
Discharge w/ Fish smell
Vag swab (Clue cells, pH > 4.5)
Mx: Metronidazole
63
Q

Candidiasis Features

A

Thick discharge, Itch + Pain

Mx: Vag/Top Cotrimoxazole, PO Fluconazole

64
Q

Chlamydia Features

A

Abnormal discharge/bleeding, Pain

Mx: PO Doxy 100mg BD 7 days

65
Q

Chlamydia Complication

A

LGV (Lymphogranuloma Venereum)
=> Painless Ulcer, Lymphadenitis, Proctitis/Proctocolitis
Mx: PO Doxy 100mg BD 21 days

66
Q

Gonorrhoea Features

A

Green/Yellow Discharge, Pain

Mx: IM Ceftriaxone 1g

67
Q

Mycoplasma Genitalum Features

A

Urethritis (Excl Gonnorhoea: NAAT Vag swab)

Mx: Doxy 100mg 7 days, Azithromycin 1g and 500mg OD 2 days

68
Q

Trichomonas Features

A

Frothy discharge, Itch/Pain +/- Smell
(Strawberry Cervix, pH >4.5)
Mx: Metronidazole

69
Q

HSV Features

A

Reg Aciclovir

Sores: Instillagel

70
Q

Syphilis Features

A

Painless Ulcer, Rash, Lymphadenopathy
(Ab testing for T. Pallidum)
Mx: Deep IM Benzylpenicillin, Full STI Screen

71
Q

Disseminated Gonococcal Inf Triad

A

Tenosynovitis
Migratory Polyarthritis
Dermatitis

72
Q

Prim Amenorrhoea Def

A

Fail to menstruate by 15yo (w/ normal Second Sex characteristics) or by 13yo (w/ no Second Sex characteristics) or no progress for > 2yrs

73
Q

Dysmenorrhea Mx

A

NSAID (Mefenamic Acid), Paracetamol
COCP
POP/Implant
IUS

Medicine (13 decks)

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