Gynae 2017 Flashcards
GnRH pulses come from?
Where does stimulation of FSH/LH release come from?
Oestrogen is produced by the folllicle but has a negative feedback on FSH, why?
What stimulates the LH surge?
What is progesterone then produced by?
What does progesterone do in pregnancy?
Hypothalamus Anterior pituitary So only one egg matures High levels of oestrogen Corpus luteum Maintains the lining of the womb
Amenorrhea ix?
Bloods - FSH/LH, oestrogen, progesterone, prolactin, testosterone, TFTs
Pregnancy test
TVUS
US adrenals
MRI pituitary
Karyotyping
Give at least 1 primary and 1 secondary cause of amenorrhea for each category Central Endocrine Ovarian Genital tract Other
Central
1-hypothalamic hypogonadism, hyperprolactinaemia, kallmans syndrome
2-hypothalamic hypogonadism, hyperprolactinaemia, Sheehan syndrome
Endo
1- Thyroid, CAH, adrenal tumour
2-Thyroid, adrenal tumour
Ovarian
1-PCOS, androgen insufficiency, Turner syndrome
2-PCOS, androgen insufficient, premature failure
Genital tract
1- imperforate hymen, transverse vaginal septum
2- cervical stenosis, ashermans syndrome
Other
1-constitutional delay, childhood radiotherapy
2- pregnancy, lactation, menopause, progesterone
Common sites of endometriosis tissue?
Uterosacral ligaments
Ovaries - chocolate cyst
Also can get tissue in rectum, bladder, vagina and lungs
PCOS management of Insulin resistance? Hirtuism Irregular ovulation Infertility
Metformin
COCP, spironolactone
COCP
Clomifene
How long after last period before menopause?
12 months
Some early, medium and late Sx of menopause?
Early
Irregular periods, vaginal dryness, poor concentration, headaches, reduced libido, joint pain, vasomotor (flushes, night sweats)
Medium
GU - frequency, urgency, nocturia, UTIs
Atrophic vaginitis, PMB
Late
Osteoporosis, dementia, CVD
What are and what can help with vasomotor sx of menopause?
Hot flushes, night sweats
Progesterone
Benefits of HRT? Risks?
Symptom management, osteoporosis prevention, colorectal cancer prevention
Breast cancer risk if combined
Endometrial cancer if oestrogen only
Gallbladder disease
A married couple in their thirties presents to the gynaecologist. They are struggling to conceive
The lady has a BMI of 32 and drinks 12 units/week. The man smokes 10/day and drinks 15 units/week. What pre-conception advice do you give them?
You ask the man for a sperm sample. What are you looking for? What might reduce his sperm quality?
What test can you do to check for ovulation? What are ovulatory factors for infertility? (hint, think amenorrhoea)
You suspect it might be tubal factors. What can cause this? What investigations can you do?
How many cycles of IVF can this couple have on the NHS? What are the risks associated?
Start folic acid, female stop drinking, man stop smoking, lose weight
COUNT, MORPHOLOGY, MOTILITY
Smoking, obesity, klinfelters, varicocele, prolactin, hypothalamic hypogonadism
Day 21 progesterone
PCOS, hypothalamic hypogonadism, hyperprolactinaemia, premature ovarian failure, adrenal tumour, thyroid
PID, surgical adhesions, endometriosis
Laparoscopy and methylene blue dye, hysterosalpingogram
3 as they are aged under 40
Multiple pregnancy, ectopic, infection from egg collection, ovarian hyperstimulation syndrome, miscarriage
What is methylene blue dye used for?
Injected into cavity of uterus -> fills the tubes and then they become distended as fill with dye then it spills out into the abdomen though the open ends
Checks for tubal patency
What do you se a hysterosapingogram for?
Test for tubal infertility
X-ray after uterus and Fallopian tubes filled with contrast (fluoroscopy)
Difference between miscarriage and intrauterine death?
24 weeks gestation is the cut off
Risk factors for miscarriage ?
Previous Age BV Uterine anatomy Medical Eg antiphospholipid
Difference between complete and incomplete GTD
C- sperm plus empty egg
I- 2 sperm 1 egg
Molar pregnancy What is it termed if it becomes invasive and metastasises? Are hCG levels low or high? What is seen on US scan? What is the management?
Choriocarcinoma
Very high
Snowstorm
Suction curettage, monitor hCG
Ectopic pregnancy Most common location? Risk factors? Why do you get shoulder tip pain? Characteristic sign on pelvic examination? What happens to hCG levels?
Most common location?
Ampulla of fallopian tube
Risk factors?
PID, age, IUD, Pelvic surgery, smoking , previous ectopic
Why shoulder tip pain?
Diaphragmatic irritation from blood if ruptures
What is the characteristic sign on pelvic examination?
Cervical excitation
What happens to the HCG?
Doesn’t increase by 2/3 in 24 hours
Ectopic
Initial mx steps?
Surgical procedure?
When can you use a medical procedure and what is it?
What is your initial management?
ABCDE, NBM, FBC and crossmatch, anti-D
What is the surgical procedure?
Laparoscopy and salpingectomy (or salpinostomy)
When can you use medical management and what is it?
Methotrexate injection if HCG<3000, stable, no foetal cardiac activity, unruptured
