Gynae 2017 Flashcards

Question

Cervical cancer Ix?

Answer 1

Colposcopy and biopsy | ±cystoscopy and MRI to stage

Answer 2

1ai: loop excision cone biopsy (LLETZ) 1aii-1bi: fertility preserving sergery 1aii-2a LN-: hysterectomy or chemoradio 1aii-2a LN+ or >2b: chemoradio w/o surg

Answer 3

Ix: Transvaginal US (measure endometrial thickness) Hysteroscopy (if >4mm or multiple episodes) and pipelle biopsy Mx: (depends on stage) Surgery: total abdominal or laparoscopic hysterectomy + BSO +/- pelvic LN removal Radiotherapy: locally to LNs, adjuvant to surgery Medical: progesterone (only if unfit for surg)

Answer 4

1a-endometrium only B- <1/2 of myometrium C >1/2 of myometrium 2a cervical glands 2b cervical stroma 3a ovary B vagina C lymph nodes 4 a local organs B regional organs

Answer 5

Vague sx -> late presentation

Answer 6

Predisposing condition Eg VIN, oncogenic HPV Lichen sclerosis, immunosupresion, smoking, Paget’s disease of vulva V non specific Eg vulval pain, persistent lump, bleeding, discharge ±dysuria / dyspareunia Examination and biopsy Surgical - conservative or radical excision

Answer 7

Protrusion of the uterus/vagina beyond the normal anatomical confines

Answer 8

Urethrocoele Prolapse of the lower vaginal anterior wall Involves urethra only Cystocoele Prolapse of the Upper vaginal anterior wall Involves bladder ± urethra

Answer 9

Apical prolapse | Prolapse of the uterus (or vault if hysterectomy), cervix and upper vagina

Answer 10

Rectocoele Prolapse of the Lower vaginal posterior wall Involves anterior wall of rectum Enterocoele Prolapse of upper vagina posterior wall Involving bowel loops or pouch of douglass

Answer 11

0 - no degree of decent of pelvic organs while straining 1- leading surface >1cm above hymenal ring 2- leading surface 1cm above - 1cm below hymenal ring 3- extends >1cm below hymenal ring without complete vaginal eversion 4- complete vaginal eversion

Answer 12

Multiparity Vaginal delivery Menopause Iatrogenic - Eg pelvic surgery Pelvic mass Increased intraabdominal pressure - obesity, chronic cough, constipation Congenital abnormality of collagen - Eg ehlers danlos

Answer 13

May be ASx “something coming down…” Dragging sensation Dysparunia Backache If anterior: urinary frequency, urgency, retention If posterior: constipation +/- digital reduction

Answer 14

Biannual examination and sims speculum vaginal examination Mx General: lose weight, pelvic floor exercises, treat cough/stop smoking Pessaries: cones, ring or shelf pessaries (changed every 6-9 months) Surgical: hysteroplexy/vaginal hysterectomy for uterine prolapse anterior repair for cystocoele posterior repair for rectocoele sacrospinous fixation for vault prolapse

Answer 15

Involuntary leakage of urine on exertion/coughing/sneezing due to urethral sphincter weakness which leads to social or hygiene problems and is objectively demonstrable Postmenopausal Vaginal delivery - esp prolonged / forceps Muliparity Obesity

Answer 16

Urine dipstick – check for signs of UTI Urine diary – for at least 3 days, shows leaks Cystometry – to exclude OAB Management: Conservative: physiotherapy for pelvic floor muscle training (for ≥ 3 months)Decrease weight, caffeine, smoking and constipation Reassurance and support Medical: SNRI e.g. duloxetine Surgical: mid-urethral sling procedure e.g. tension-free vaginal tape

Answer 17

Overactive bladder Uncontrolled increase in detrusor pressure leading to increased bladder pressure, beyond that or normal urethra, leading to social or hygiene problem ``` Urinary urgency and urge incontinence Urinary frequency Nocturia/nocturnal enuresis May have triggers e.g. key in the door May have Hx of childhood enuresis or fecal urgency ```

Answer 18

Investigations: Urine diary – frequent voiding of small volumes +/- high caffeine intake Cystometry – detrouser contractions on filling or provocation (not indicated initially) Management: Conservative: decrease fluid intake esp. caffeine, review diuretic usebladder retraining (education, timed voiding, positive reinforcement) Medical: anticholinergic e.g. oxybutinin vaginal oestrogens if post-menopausal botox injections into detrusor Surgery: ileocystoplasty if severe Other: neuromodulation and sacral nerve stimulation

Answer 19

Infection of the upper female genital tract may be due to ascending infection from endocervix e.g. STI or decending infection from enteric organs e.g appendix ``` Age <25 Previous STI Post-partum endometriosis Multiple partners Uterine instrumentation - Eg Surgical TOP / IUCD ```

Answer 20

Lower abdo pain – may be constant or intermittent, unilateral or bilateral Deep dysparunia Vaginal discharge Fever Changes to bleeding e.g. oligomenorrhoea, dysmenorrhoea, IMB or PMB Tenderness in adnexal area +/- cervical excitation on PV examination n.b. may be asymptomatic and retrospective diagnosis e.g on investigation of subfertility

Answer 21

Investigations: Bloods: ↑WCC and ↑CRP, chlamydia and gonorrhoea NAAT Gonorrhoea cervix culture ? USS or laparoscopy Management: Multiple abx to cover all potential causative organisms e.g. ceftriaxone, azithromycin, doxycline and metronidazole Contact tracing and treatment of sexual partners