Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

YEAR 5 SPECIALTIES KEY INFO > GYNAE 2: IMB, PCB, Pruritus Vulvae, STIs, Urinary Sx > Flashcards

GYNAE 2: IMB, PCB, Pruritus Vulvae, STIs, Urinary Sx Flashcards

1
Q

What are some causes of IMB?

A
  • contraceptives
  • cervical cancer (abnormal vaginal bleeding, pelvic pain, dyspareunia)
  • endometrial cancer (pelvic pain, weight loss, PMB)
  • PID/STIs (lower abdo pain, dysuria, abnormal vaginal discharge)
  • atrophic vaginitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is IMB investigated?

A

Speculum
Bimanual examination

STI screen
Bloods
Pregnancy test
Cervical screening
Pelvic USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the different types of contraceptives?

A

Barrier - condoms
Oral - COCP, POP
Injectable - medroxyprogesterone acetate
Implantable - etonogestrel
Intrauterine - IUD, IUS
Patch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the mode of action of the COCP and when is it indicated?

A

MOA = inhibits ovulation

BENEFITS/INDICATIONS =
- acne
- heavy or painful periods
- PMS
- endometriosis
- PCOS
- reduced ovarian/endometrial cancer risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are risks/contraindications of the COCP and what are its side effects?

A

RISKS/CONTRAINDICATIONS =
- missed pill
- VTE
- breast/cervical cancer
- stroke/IHD

SEs = headache, nausea, breast tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What advice should be given when starting the COCP?

A
  • take additional contraception if not started within first 5 days of cycle
  • take at same time everyday
  • can tricycle or pill-free break
  • less efficacy when vomiting within 2hrs, medication induces diarrhoea/vomiting, liver enzyme inducing drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What advice should be given in the case of a missed COCP pill?

A

1 pill missed = take last pill even if 2 in one day, continue as normal

2 or more pills missed:
- take last pill even if 2 pills taken in 1 day
- use barrier protection/abstain until pills are taken 7d in a row
- WEEK 1 = emergency contraception if UPSI in pill-free interval or week 1
- WEEK 2 = if pills are taken 7 days in a row no need for emergency contraception
- WEEK 3 = finish pills in current pack, start new pack next day (no pill-free interval)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are UKMEC 4 contraindications to the COCP?

A
  • > 35yo and >15 cigarettes/day
  • migraine w/aura
  • hx thromboembolic disease/thrombogenic mutation
  • PMHx of stroke/IHD
  • breastfeeding <6w post-partum
  • uncontrolled HTN
  • current breast cancer
  • major surgery + prolonged immobilisation
  • +ve antiphospholipid antibodies e.g. in SLE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are UKMEC 3 contraindications to the COCP?

A
  • > 35yo and <15 cigarettes/day
  • BMI >35
  • FHx thromboembolic disease in first degree relatives
  • controlled HTN
  • immobility e.g. wheelchair use
  • carrier of gene mutations assoc. w/breast cancer e.g. BRCA1/2
  • current gallbladder disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do the UKMEC levels mean?

A

1 = no contraindication
2 = advantages > disadvantages
3 = disadvantages > advantages
4 = unacceptable health risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the mode of action, side effects and benefits/indications of the POP?

A

MOA = thickens cervical mucus

SEs = irregular bleeding

Benefits/indications =
- painful/heavy periods
- endometriosis
- can take immediately after birth/breastfeeding
- oestrogen is contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the types of POP?

A

Traditional = Micronor, Noriday, Nogeston, Femulen

Desorgestrel pill = Cerazette

Drospirenone pill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What advice should be given when starting the POP?

A

TRADITIONAL/DESOGESTREL:
- if started day 1-5 protected immediately, otherwise take extra contraception for 2 days

DROSPIRENONE PILL:
- only protected if taken on day 1, otherwise take extra contraception for 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What advice should be given for a missed POP?

A

TRADITIONAL POP:
- less than 3 hours late, no action required
- more than 3 hours late = take missed pill ASAP, continue w/rest of pack, extra precaution for 38hrs

DESORGESTREL PILL:
- less than 12 hours late, no action required
- more than 12 hours late, see above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How should the combined contraceptive patch (Evra) be used?

A

Lasts 4 weeks

First 3 weeks = wear patch every day, change weekly

Last week = withdrawal bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What advice should be given if there is a delay in changing patch?

A

End of week 1 or 2:
- <48hrs = change immediately, no further precautions
- >48hrs = change immediately, use barrier contraception for 7d (UPSI in last 5d or SI in patch-free interval, emergency contraception)

Week 3: remove patch, start new patch on usual cycle start day for next cycle, no additional contraception

Delayed patch application at end of patch-free week: additional contraception for 7d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Summarise the injectable contraceptive?

A

MOA: inhibits ovulation, thickens cervical mucus

Instructions = IM injection every 12 weeks

PROS = missed pill

CONS = delayed return to fertility up to 1yr

SEs = irregular bleeding, weight gain, osteoporosis

CIs = current/past breast ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Summarise the implantable contraceptive?

A

MOA = inhibits ovulation, thickens cervical mucus

Instructions = subdermally in proximal non-dominant arm

PROs = most effective, lasts 3yrs, doesn’t contain oestrogen, insertion after TOP

CONs = professional insertion, need additional contraceptive for first 7d

SEs = irregular/heavy bleeding, headache, nausea

CIs = anti-epileptics, rifampicin, current breast Ca (UKMEC4), IHD/stroke, vaginal bleeding unexplained, past breast Ca, severe liver cirrhosis, liver Ca (UKMEC3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Summarise the IUD?

A

MOA = decreased sperm motility and survival

Instructions = can rely on use immediately

PROs = 5-10yr use

CONs = uterine perforation, increased risk of ectopics, infection, expulsion

SEs = heavier, longer, more painful periods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Summarise the IUS?

A

MOA = prevents endometrial proliferations, cervical mucus thickening

Instructions = can rely on use after 7d

PROs = effective for 5yrs, can use as part of HRT for 4yrs

CONs = uterine perforation, increased risk of ectopics, infection, expulsion

SEs = frequent uterine bleeding and spotting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the different options for emergency contraception?

A

IUD

Levonorgestrel

Ulipristal (EllaOne)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

IUD - emergency contraception advice

A
  • most effective so offered to all women
  • only insert within 5d of UPSI or within 5d of likely ovulation date
  • inhibits fertilisation OR implantation
  • can be kept in-situ for long term contraception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Levonorgestrel - emergency contraception advice?

A
  • stops ovulation and inhibits implantation
  • must take within 72hrs of UPSI
  • single dose 1.5mg or double if BMI >26 or weight >70
  • vomiting occurs in 3hrs = repeat dose
  • can take hormonal contraception immediately
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Ulipristal - emergency contraception advice?

A
  • 30mg oral dose
  • must take within 5d of UPSI
  • restart hormonal contraceptive 5d later
  • avoid in severe asthma
  • avoid breastfeeding for 1w
25
Q

What questions should you ask when seeing a person seeking emergency contraception?

A
  • how many days since UPSI?
  • do you normally take hormonal contraception?
  • do you breastfeed?
  • what is your weight/BMI?
  • PMHx of asthma?

Counselling = return to GP if vomiting

26
Q

Outline contraceptive options for postpartum?

A

COCP:
- contraindicated before 6w if breastfeeding
- avoid in first 3w due to increased VTE risk
- UKMEC2 if breastfeeding for 6w to 6mths - use additional contraception for first 7d

POP:
- can start any time post partum
- after day 21 use additional contraception for first 2d

IUD/IUS:
- can be inserted within 48hrs of birth OR after 4w

Lactational amenorrhoea:
- fully breastfeeding + amenorrhoea + <6mths post partum

27
Q

What is endometrial hyperplasia?

A

Abnormal proliferation of endometrium - assoc. w/HPV 16, 18 and 33

Types inc. simple, complex, simple atypical and simple complex

Features inc. abnormal vaginal bleeding e.g. IMB

28
Q

How is endometrial hyperplasia without atypia managed?

A
  • PO or local IUS for 6mths
  • continuous progestogens for women who decline IUS
  • hysterectomy
  • bilateral salpingo-oophorectomy added for postmenopausal women
29
Q

How is endometrial hyperplasia with atypia managed?

A

Laparoscopic total hysterectomy
Bilateral salpingo-oophorectomy should be added for post menopausal women

30
Q

What are risk factors for endometrial cancer?

A

EXCESS OESTROGEN:
- nulliparity
- early menarche
- late menopause
- unopposed oestrogen e.g. HRT
- metabolic syndrome e.g. obesity, diabetes, PCOS
- tamoxifen
- HNPCC

31
Q

How is endometrial cancer investigated?

A

Suspected cancer pathway if >55yo w/PMB

TVUSS
Hysteroscopy w/endometrial biopsy

32
Q

How is endometrial cancer managed?

A

LOCALISED = total abdominal hysterectomy w/BSO

HIGH RISK = post op radiotherapy

33
Q

What are some causes of PCB?

A
  • cervical cancer
  • cervical ectropion
  • atrophic vaginitis
  • PID
  • polyps
34
Q

What is a cervical ectropion?

A

Larger area of columnar epithelium present on ectocervix caused by elevated oestrogen levels

Transformation zone = area between native and unaffected columnar epithelium of the endocervical canal and native squamous epithelium

Squamo-columnar junction = abrupt change from columnar cells to squamous cells (hence SCC most common type of cervical cancer)

Location depends on age, hormonal status, birth trauma, contraceptives, pregnancy

35
Q

How is a cervical ectropion investigated and managed?

A

Ix = speculum

Mx = no treatment, but if symptomatic can cauterise w/silver nitrate or cold coagulation

36
Q

What is CIN? What are the stages?

A

CIN = abnormal changes of cells that line the cervix with mild/moderate dyskaryosis

CIN 1 = 1/3 depth of surface of cervix

CIN 2 = 2/3 depth of surface of cervix

CIN 3 = whole thickness of surface of cervix

37
Q

How is CIN managed?

A

If CIN 2/3 = LLETZ, cone biopsy

If CIN 1 = watch and wait, screen again in 12 months

38
Q

What is cervical cancer, what are the 2 types?

A

Highest incidence in people aged 25-29yo

SCC = 80%
Adenocarcinoma = 20%

39
Q

What are risk factors for cervical cancer?

A
  • HPV 16&18
  • smoking
  • HIV
  • early first intercourse
  • many sexual partners
  • high parity
  • lower SES
  • COCP
40
Q

How is cervical cancer investigated?

A

Screening programme = HPV first system
- 25-49 = 3yrly screening
- 50-64 = 5yrly screening

Delayed until 3mths post partum
Can opt out if never sexually active

41
Q

How does cervical cancer screening progress based on HPV results?

A

-ve HPV = return to normal recall

+ve HPV = check cytology

normal = repeat in 12 months

abnormal = colposcopy, then mx

inadequate sample = repeat in 3 months

NOTE: HPV strains inc. 16, 18, 33

42
Q

How is cervical cancer managed?

A

Stage IA1 = microinvasive disease
- loop electrosurgical excision and conization
- simple hysterectomy if no wish for fertility

Stage IA2 - IB2 = early stage disease
- radical hysterectomy and bilateral salpingectomy and/or bilateral oophorectomy w/bilateral pelvic lymphadenectomy
- may consider adjuvant chemo/radio if high risk

Stage IB3 - IVA (locally advanced disease)
- external beam radiotherapy, intracavity brachytherapy, concomitant chemotherapy
- surgency not recommended

Stage IVB (spread to distant organs)
- systemic chemotherapy

Recurrent/metastatic disease = salvage surgery or chemo/radiotherapy

43
Q

Outline chlamydia investigations, screening and management?

A

Most prevalent STI in UK, incubation period 7-12d

Sx = asymptomatic in most, may have discharge, bleeding, dysuria

Ix = NAATs using urine, vulvovaginal swab or cervical swab, 2w post exposure

Screening open to everyone 15-24

Mx = 7d doxycycline (if pregnant: azithromycin, erythromycin, amoxicillin), partner notification w/offer of treatment

44
Q

What are some complications of chlamydia?

A

PID, endometritis, ectopic, infertility, reactive arthritis, perihepatitis

45
Q

Summarise gonorrhoea?

A

Organism = gram-negative diplococcus, Neisseria gonorrhoea

Sx = cervicitis (abnormal discharge)

Complications = dissemination, damage to urethral structures, salpingitis

Dissemination - most common cause of septic arthritis, initially tenosynovitis, migratory polyarthritis, dermatitis. Later = septic arthritis, endocarditis, perihepatitis

Mx = IM ciprofloxacin 1g, 2nd line = oral cefixime 400mg + oral azithromycin

46
Q

Summarise trichomonas vaginalis?

A

Organism = flagellated protozoan parasite

Sx = frothy, yellow-green discharge, vulvovaginitis, strawberry cervix, pH >4.5

Ix = microscopy of wet mount - motile trophozoites

Mx = oral metronidazole 5-7d

47
Q

What is PID?

A

PID = infection of female pelvic organs and surrounding peritoneum. Ascending infection from endocervix.

Most common cause = chlamydia trachomatis

Sx = dysmenorrhoea, fever, deep dyspareunia, dysuria, abnormal discharge, cervical excitation, violin string appearance, RUQ pain

48
Q

How is PID investigated and managed?

A

Pregnancy test, high vaginal swab, screen for chlamydia and gonorrhoea

Mx = IM ceftriaxone 1g, PO doxycycline 100mg BD, PO metronidazole 400mg BD for 14d + consider removing IUD/IUS

49
Q

What are some complications of PID?

A

Fitz-Hugh Curtis syndrome
Infertility
Chronic pelvic pain
Ectopic pregnancy

50
Q

Summarise bacterial vaginosis?

A

BV = overgrowth of anaerobic organisms e.g. Gardnerella vaginalis

Sx = fishy offensive discharge, asx in 50%, vaginal pH >4.5

Dx = Amsel’s criteria 3/4
- grayish, white discharge coating vaginal walls
- vaginal pH >4.5
- +ve whiff test
- clue cells on wet prep

Mx = asx no mx, sx = oral metronidazole for 5-7d

51
Q

What are causes of pruritus vulvae?

A

Atrophic vaginitis
Lichen sclerosus

52
Q

Outline atrophic vaginitis?

A
  • thinning and drying of vaginal walls

Sx = vaginal dryness, dyspareunia, occasional spotting

Ix = speculum, pale and dry vaginal wall

Mx = vaginal lubricants and moisturisers, topical oestrogen cream
(if menopausal/post menopause w/other sx consider HRT clinic referral)

53
Q

Summarise lichen sclerosus?

A

Inflammatory condition leading to atrophy of epidermis and white plaque formation.

Sx = white patches, itching, dyspareunia, dysuria

Ix = speculum + external genitalia exam

Mx = topical steroids and emollients, f/u due to increased risk of vulval cancer
- 1st line = topical clobetasol propionate
- 2nd line = topical tacrolimus (only initiated in specialist clinics)

54
Q

What are causes of urinary incontinence?

A

Overactive bladder/urge incontinence = bladder oversensitivity from infection or neurologic disorders

Stress incontinence = relaxed pelvic floor, increased abdo pressure

Mixed incontinence

Overflow incontinence = urethral blockage, bladder unable to empty properly

55
Q

Summarise urge incontinence?

A

Detrusor overactivity

Sx = urge to urinate followed by uncontrollable leakage

Ix = bladder diaries for 3d, vaginal exam, urine dip and culture, urodynamic studies

Mx = bladder retraining for min. 6w, bladder stabilising drugs e.g. antimuscarinics (oxybutynin, tolterodine, darifenacin), beta-3-agonist (mirabegron) if frail and elderly

56
Q

Summarise stress incontinence?

A

Leakage of urine with increased intra-abdominal pressure

RFs = childbirth, hysterectomy, FHx, advancing age, high BMI

Ix = bladder diaries for 3d, vaginal exam, urine dip and culture, urodynamic studies

Mx = pelvic floor muscle training (8 contraction 3x/day for 3 months), duloxetine, surgical procedures

57
Q

What are the different types of urogenital prolapse?

A

Cystocele
Uterine prolapse
Rectocele
Enterocele

58
Q

Summarise urogenital prolapse?

A

Descent of a pelvic organ, leading to protrusion on the vaginal walls

RFs = increased age, multiparity, vaginal deliveries, obesity

Sx = pressure, heaviness, bearing down, urinary sx

Ix = bimanual/speculum, bladder diaries for 3d, urine dip and culture, urodynamic studies

Mx = asx no mx, conservative - weight loss, pelvic floor muscle exercise, ring pessary, surgery (cystocele = anterior colporrhaphy; vaginal vault prolapse = sacrocolpopexy)

YEAR 5 SPECIALTIES KEY INFO (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions