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Obs & Gynae > Gynae 3 > Flashcards

Gynae 3 Flashcards

1
Q

What are fibroids, how do they present, what would you find on examination, and what are the investigations?

A

1) monoclonal tumours of smooth muscle cells of the uterine myometrium
2) 30-50y. excessive bleeding/prolonged heavy periods/ intermenstrual bleeding/lower abdo discomfort, fullness

3) examination: palpable abdominal mass, enlarged irregular uterus
4) investigations: pelvic USS/MRI/hysteroscopy

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2
Q

what is the management for uterine fibroids?

A

pharmacological: NSAIDs/tranexamic acid/IUS/GnRH analogues pre-hysterectomy
surgical: myomectomy/ablation/hysterectomy

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3
Q

what are the causes of intermenstrual bleeding?

A 
physiological
vaginal: vaginitis, tumours
cervical: cervical ectropion, chlamydia, gonorrhoea
uterine: fibroids, cancer
any oestrogen dependent tumours
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4
Q

what are the causes of postcoital bleeding?

A

cervical ectropion
cervical polyps
cervical cancer
vaginal cancer

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5
Q

what are the investigations of abnormal vaginal bleeding?

A 
pregnancy test
infection screen
TVS (preferably postmenstrually)
speculum examination 
FBC, FSH, LH, clotting 
endometrial biopsy
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6
Q

what is the management of dysmenorrhoea?

A

primary: offer NSAID (ibuprofen, naproxen, mefanemic acid), if insufficient, add hormonal contraception, heat application, TENS

secondary (later in life onset): abdominal exam and pelvic exam

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7
Q

what are the differentials of dysmenorrhoea?

A

endometriosis
fibroids
PID

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8
Q

What is primary and secondary amenorrhoea?

What are the causes of primary amenorrhoea?

A

Primary amenorrhoea: failure of menstruation before 16y
Secondary: failure of menstruation for >6+ in an individual who has had previously had periods for >12m or more

Causes:
Secondary sexual characteristics?
Yes: hyperprolactinaemia, testicular feminisation, GU abnormalities (imperforate hymen, absent uterus), constitutional

No: ovarian insuffiency, hypothalamic insuffiency, hypothalamic-pituitary insuffiency (Kallmann’s, Prader-Wili)

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9
Q

What are the most common causes of secondary amenorrhoea?

A

Pregnancy
PCOS
Hypothalamic amenorrhoea
Hyperprolactinaemia

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10
Q

What are all of the possible causes of secondary amenorrhoea?

A

Signs of androgen excess?
No = pregnancy/lactation/menopause, hyperprolactinaemia, Asherman’s syndrome, premature ovarian failure, contraception, anorexia

Yes = PCOS/Cushing’s/adrenal carcinoma

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11
Q

What are the investigations for amenorrhoea?

A

pregnancy test
FSH/LH (raised in ovarian failure, decreased in hypothalamic/pituitary failure)
TFTs
total testosterone and sex hormone binding globulin
USS

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12
Q

What are the causes of male infertility?

A

obesity/smoking/tight fitting underwear/alcohol/illicit drugs

disorders of testis and spermatogenesis:
klinefelter's
kallmann's
testicular tumours 
cushing's
pituitary tumours 
disorders of the genital tract:
hypospadias (semen deposited in vagina instead of cervix)
erectile dysfunction
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13
Q

What occurs in kallmann’s syndrome?

A

hypogonadotrophic hypogonadism
hyposmia/anosmia
decreased GnRH = prevents puberty from happening in the first place

lack of primary and secondary sexual characteristics in males and females

diagnosis: decreased GnRH, decreased LH/FSH, other pituitary tests are fine

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14
Q

What occurs in klinefelter’s sydnrome?

A

47XXY
increased FSH/LH will be seen as leydig and sertoli cells do not produce as much testosterone and inhibin

hypogonadism, sterility, tall long legs, gynaecomastia

can be diagnosed using amniocentesis (for karyotyping) and a blood test

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15
Q

In a history of male infertility, what would you ask?

A 
Smoking/alcohol/drugs
Prior children
genetic disorders
sense of smell
nocturnal emissions
puberty normal?
painful ejaculating
urinary symptoms
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16
Q

what investigations would you do for male fertility?

A

semen analysis (produced by masturbation after 3 days abstinence. repeat test in 3m)
FSH/LH
USS
testicular biopsy

17
Q

what is the management for abnormal sperm counts?

A

loose fitting underwear/no laptops on lap etc
surgical correction of epidydmal blockage
men w/ hypogonadotropic hypogonadism (offered gonadotropins)

18
Q

what are group I, II and III ovulation disorders?

A

I: hypothalamic pituitary failure (e.g. hypothalamic amenorrhoea, hypogonadotropic hypogonadism)
II: dysfunctions of the hypothalamic pituitary axis (e.g. PCOS)
III: ovarian failure

19
Q

what is the treatment of group I, II and III ovulation disorders?

A

group I: increase body weight, offer pulsatile GnRH

group II: clomifene citrate (SERM) stimulates GnRH production and is the initial treatment
metformin
ovarian drilling

disorders due to hyperprolactinaemia = offered treatment with dopamine agonists e.g. bromocriptine (as dopamine inhibits prolactin)
ovarian hyperstimulation = anastrozole, clomifene citrate

20
Q

What occurs in IUI?

A

intrauterine insemination
introduction of prepared sperm into the vaginal canal
good for same sex couples, couples who struggle to have sex, after sperm washing where the man is HIV positive

21
Q

what hormones are used in IVF during egg retrieval?

A

ovarian stimulation initially with ultrasound monitoring

progesterone is used after for luteal phase support

22
Q

what is the access criteria for IVF?

A

women <40 should be offered three cycles
women who reach 40 during treatment should not be offered further cycles
women >40 should be offered one cycle as long as: never had IVF before, no evidence of low ovarian reserves

single embryo transfers are used

23
Q

what happens in ICSI?

A

intracytoplasmic sperm injection (ICSI)
single sperm is injected directly into oocyte
used for couples whom IVF did not work, or those with reduced semen quality

24
Q

what are the causes of female infertility?

A

sheehan’s disease
hyperprolactinaemia
turner’s/klinefelter’s

PID
STI's
Asherman's syndrome
Bicornuate uterus 
endometriosis
25
Q

what investigations would you do for female infertility?

A 
mid-luteal progesterone
FSH/LH/GnRH levels
USS
hysterosalpingogram
laparoscopy and dye test 
ovarian reserve test
26
Q

in a PMH and examination of a female infertile patient what should you ask?

A

PCOS/SLE/CKD/diabetes/anaemia/anorexia?

PCOS signs
abdominal examination
bimanual/spec
vaginal examination

Obs & Gynae (10 decks)

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