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Gynae Flashcards

1
Q

causes of menorrhagia

A

endometriosis
adenomyosis
polyps
fibroids
coagulation disorders
thyroid issues
IUD
Malignancy

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2
Q

Causes of amenorrhoea

A

primary - no periods by 15. Turners, anorexia, imperforate hymen, congenital adrenal hyperplasia
secondary - 3-6months no period. Pregnancy, menopause, primary ovarian insufficiency, hypothyroidism, IUS, sheehans, excessive exercise, PCOS

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3
Q

Causes of dysmenorrhoea

A

primary - occurs in 50% of women, No cause identified. Treat with NSAIDs like mefanamic acid
secondary - endometriosis, adenomyosis, fibroids, PID, IUD

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4
Q

what is adenomyosis and features

A

deposition of endometrial tissue in myometrium resulting in dysmenorrhoea, menorrhagia and a boggy uterus

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5
Q

first line investigation for adenomyosis

A

TVUSS

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6
Q

rx of adenomyosis

A

definitive - hysterectomy
Otherwise can give tranexamic acid and GnRH agonists

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7
Q

causes of post coital bleeding

A

cervical or vaginal cancer
cervical ectropion
vaginal atrophy
trauma

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8
Q

rx of vaginal atrophy

A

vaginal lubricants and moisturisers. If doesn’t work, can give topical oestrogen cream

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9
Q

risk factors for cervical cancer

A

HPV!! (16,18,33)
age <40
multiple sexual partners
high parity
early first intercourse
lower socioeconomic status
HIV

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10
Q

cervical cancer screening

A

smear tests offered between ages 25-64 to detect HPV. Cytology offered if positive

25-49 - 3 year screening
49-64 5 year screening

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11
Q

cervical cancer screening and pregnancy

A

wait until 3 months post party

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12
Q

cervical screening - what to do if
- negative for HPV
- positive for HPV
- inadequate sample

A
  • recall to normal screening
  • perform cytology. If positive - colposcopy. If negative - repeat at 12 months
  • repeat sample in 3 months. I still inadequate, refer for colposcopy
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13
Q

Rx of CIN

A

LLETZ - large loop excision of transformation zone

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14
Q

Rx of cervical cancer
what about if want to maintain fertility

A

Gold standard - hysterectomy
Cone biopsy if want to maintain fertility

Can also do radiotherapy

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15
Q

Complications of hysterectomy/cone biopsy

A

Standard complications (e.g. bleeding, damage to local structures, infection, anaesthetic risk)

Cone biopsies and radical trachelectomy may increase risk of preterm birth in future pregnancies

Radical hysterectomy may result in a ureteral fistula

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16
Q

Risk factors of endometrial cancer

A

Unopposed oestrogen - early menarche, late menopause, nulliparous, oestrogen only HRT

Metabolic syndrome - obesity, diabetes
PCOS
Tamoxifen
Post menopausal

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17
Q

protective factors for endometrial cancer

A

multiparty
smoking
COCP

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18
Q

Referral criteria for endometrial cancer

A

> 55 with post menopausal bleeding

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19
Q

first line ix for suspected endometrial cancer
Rx of cancer

A

TVUSS for endometrial thickness. <4mm is good

hysterectomy ± radiotherapy

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20
Q

what does endometrial hyperplasia present like

A
  • presents with abnormal bleeding eg PCB, IMB, PMB
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21
Q

Rx of typical endometrial hyperplasia and rx of atypical

A

typical - high does prog. May use levonorgestrel IUS
atypical - hysterectomy

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22
Q

Features of endometriosis

A

dysmenorrhoea
chronic pelvic pain
infertility
deep dysparaunia
Non gynae - dysuria, haeamturia, urgency, Dyschezia - painful bowel movements

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23
Q

Pelvic exam findings endometriosis

A

tender posterior fornix
reduced organ motility

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24
Q

Gold standard Ix for endometriosis

A

laparoscopy

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25
Q

first line rx of symptoms of endometriosis
what if doesn’t help
what if want to maintain fertility

A

NSAIDs or paracetamol
If not help - COCP or progesterones

If doesn’t help - GnRH analogues to induce pseudomenoause

If want to maintain fertility - endometrial ablation

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26
Q

rx of menorrhagia - if want contraception and if don’t want contraception

A

if want contraception - mirena first line, COCP second line
if not want contraception - use mefanamic acid or tranexamic acid starting on first day of periods

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27
Q

common side effects of HRT

A

breast tenderness, nausea, fluid retention and weight gain

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28
Q

complications of HRT

A

VTE risk
Oestrogen only - endometrial cancer in women with a uterus. Needs to be combined
Breast cancer - increased risk with combined HRT
Stroke risk
IHD risk if taken for >10yrs

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29
Q

2 first line investigations for infertility

A

semen analysis

serum progesterone 7 days prior to expected next period. For a typical 28 day cycle, this is done on day 21

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30
Q

interpreting day 21 serum progesterone

A

high level indicates ovulation has occurred

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31
Q

lifestyle advice for infertility

A

aim for bmi 20-25
folic acid
regular sex every 2-3 days
smoking/drinking advice

32
Q

symptoms of menopause inc long term complications

A

irregular periods, dysfunctional uterine bleeding
vasomotor sx - hot flushes, night sweats
vaginak dryness and atrophy, urinary frequency
anxiety and depression

Long term - osteoporosis, IHD

33
Q

Rx of menopause
- lifestyle
- HRT
- non - HRT

A

Lifestyle - exercise, weight loss, sleep hygiene
HRT - combined if have uterus or oestrogen only if not
Non - HRT - vaginal lubricants or oestrogen cream. For vasomotor sx - fluoxetine or citalopram, CBT

34
Q

Contraindications of HRT

A

Current or past breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia

35
Q

RF of ovarian cancer

A

many ovulations - nulliparous, early menarche, late menopause
BRCA1 or 2

36
Q

Features of ovarian cancer

A

abdominal distension and bloating
abdominal and pelvic pain
urinary symptoms e.g. Urgency
early satiety
diarrhoea

37
Q

main ix for ovarian cancer
Rx of it

A

Ca125 and ultrasound
Mostly palliative as advanced disease at presentation

38
Q

features of complex cyst.
What should they be referred on for

A

multiloculated, solid, irregular, >5cm. Any post menopausal woman with cyst should be referred to gynae
should be biopsied to exclude malignancy

39
Q

RF of ovarian torsion

A

ovarian mass: present in around 90% of cases of torsion
being of a reproductive age
pregnancy
ovarian hyperstimulation syndrome

40
Q

features of ovarian torsion

A

Sudden onset of deep-seated colicky abdominal pain.
Associated with vomiting and distress
fever may be seen in a minority (possibly secondary to adnexal necrosis)
Vaginal examination may reveal adnexial tenderness

41
Q

USS of ovarian torsion

A

whirlpool sign

42
Q

life threatening complication of ovarian induction for infertility (particularly associated with PCOS)

A

Ovarian hyperstimulation syndrome - causes fluid shift resulting in Hypovolaemic shock
Acute renal failure
Venous or arterial thromboembolism

43
Q

main causes of PID

A

top is chlamydia trachomatis
Neisseria gonorrhoea
Mycoplasma genitalium
Mycoplasma hominis

44
Q

Features of PID

A

deep pelvic pain
dyspareunia
dysuria and menstrual irregularities may occur
vaginal or cervical discharge
fever

45
Q

IX of PID

A

high vaginal swab for gonorrhoea and chlamydia
pregnancy test

46
Q

Rx of PID

A

Abx - combination of:
oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole

47
Q

Complications of PID

A

perihepatitis - fitz hugh curtis
chronic pelvic pain
infertility
increased risk of ectopic pregnancy

48
Q

Rotterdam criteria for PCOS

A

2 out of 3 of:

  • infrequent or no ovulation
  • clinical and/or biochemical signs of hyperandrogenism (hirsutism, acne, elevated levels of total or free testosterone)
  • polycystic ovaries on ultrasound scan >12 follicles (measuring 2-9 mm in diameter) in one or both ovaries and/or increased ovarian volume > 10 cm3)
49
Q

Features of PCOS

A

subfertility and infertility
menstrual disturbances: oligomenorrhoea and amenorrhoea
hirsutism, acne (due to hyperandrogenism)
obesity
acanthosis nigricans (due to insulin resistance)
hyperinsulinaemia

50
Q

Ix of PCOS

A

USS
FSH, LH, testosterone (testosterone raised, raised FSH:LH ratio)
Sex Hormone Binding Globulin (low in PCOS)

51
Q

Rx of PCOS
- general
- hirsutism
- infertility

A

General - weight loss, COCP
Hirsuitism - cocp, topical eflornithine
Infertility - clomiphene first line, may add in metformin as well

52
Q

rx of endometrial hyperplasia

A

dilatation and curettage

53
Q

definition of premature ovarian insufficiency

A

onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years

54
Q

causes of premature ovarian insufficiency

A

idiopathic - most common
bilateral oophorectomy
radiotherapy
chemotherapy
infection: e.g. mumps
autoimmune disorders

55
Q

rx of premature ovarian insufficiency

A

HRT - but won’t cover for contraception in case spontaneous ovarian activity resumes

56
Q

rx of PMS

A

mild - lifestyle - exercise, weight loss, smoking, alcohol
moderate - COCP
severe - SSRI

57
Q

rx of urge incontinence

A

bladder retraining for at least 6 weeks - diary, monitoring input and output, resisting urge etc
1st line drug: oxybutynin or mirabegron in ‘frail old ladies’

58
Q

rx of stress incontinence

A

pelvic floor training - 8 contractions 3 times per day for a min of 3 months
Surgery
Duloxetine - stimulates muscles within the sphincter so stays closed

59
Q

RF of prolapse

A

obesity
multiparous
increasing age

60
Q

presentation of prolapse

A

pressure, heaviness, bearing down
incontinence, frequency, urgency

61
Q

Fibroids presentation

A

may be asymptomatic
menorrhagia - may cause iron-deficiency anaemia
bulk-related symptoms - lower abdominal pain, bloating
urinary symptoms, e.g. frequency, may occur with larger fibroids
subfertility

62
Q

Ix of fibroids

A

TVUSS

63
Q

Rx of fibroids
- asymptomatic
- menorrhagia
- shrink/remove fibroids

A
  • no treatment other then periodic review
  • LNG-IUS, mefanamic acid, tranexamic acid
  • GnRH agonists, myomectomy, uterine artery embolisation
64
Q

What is red degeneration of fibroids

A

haemorrhage into tumour - commonly occurs during pregnancy

65
Q

features of candidiasis

A

‘cottage cheese’, non-offensive discharge
vulvitis: superficial dyspareunia, dysuria
itch
vulval erythema, fissuring, satellite lesions

66
Q

rx of candidiasis

A

oral fluconazole 150 mg as a single dose first-line
or clotrimazole pessary if contraindicated (eg in pregnancy)

67
Q

compare dischare in candida, BV and trichomonas

A

candida - Cottage cheese’ discharge, Vulvitis
Itch
BV - Offensive, thin, white/grey, ‘fishy’ discharge
Trich - Offensive, yellow/green, frothy discharge, vulvovaginitis, s trawberry cervix

68
Q

RF of vulval carcinoma

A

Human papilloma virus (HPV) infection
Vulval intraepithelial neoplasia (VIN)
Immunosuppression
Lichen sclerosus

69
Q

Presentation of vulval carcinoma

A

lump or ulcer on the labia majora
inguinal lymphadenopathy
may be associated with itching, irritation

70
Q

ix for urnary incontinence

A

bladder diaries
vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
urine dipstick and culture
urodynamic studies

71
Q

when can expectant management be used for an ectopic

A

An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L and declining

72
Q

Indicatiion for medical management in ectopic and what is it

A

<35mm
unruptured
nonsignificant pain
no heart beat
bHCG <1500

Give methotrexate, must be willing to come back for follow up

73
Q

indication for surgical management in ectopic pregnancy and what is it

A

> 35mm
ruptured
pain
fetal heartbeat
bHCG >5000

salpingectomy if no other risk factors for infertility
slpingotomy if risk factors eg contralateral tube damage

74
Q

primary ovarian insufficiency blood results

A

Raised FSH and LH
Low oestrogen

75
Q

COCP missed pill rules
- if one pill
- if 2 pills

A

if one - take when remember, no other measures needed

0-7 days - emergency contraception + barrier for 7 days
wk 2 - take missed + 7 day barrier
wk 3 - take missed. omit pill interval. + barrier for 7 days

76
Q
A

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