Gynae Flashcards

1
Q

Endocervical chlamydia swab

A

Turn 10-30 secs

White

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2
Q

Swabs prep

A

I will insert a small plastic tube into your vagina. I will then insert thin swabs into your vagina and the neck of your womb. It should no be painful and if it is too uncomfortable at any point just say so and I will stop.
In order to do this, I will need you to undress from the waist down. To bring your heels to your bottom and let your knees flop out to the side. Please cover yourself with the drape. There will be a nurse present throughout for your comfort and will act as a chaperone.
Would you like to empty your bladder?
LMP, spotting, last smear?

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3
Q

Explaining colposcopy

A

Mild dyskariosis = not cancer
Abnormal cells that have numerous causes
Similar set up to smear test. The doctor uses a microscope to have a closer look. They then use a dye which highlights abnormal cells. They may remove a small bit of tissue for further investigations.
If abnormal area seen may treat it then or organise another appt.
Use hot or cold therapy to get rid of abnormal cells.
Afterwards: spotting, no sex or tampons for 1 week
F/u appt 4-6 months

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4
Q

Swabs order

A

Smear
High cervical charcoal - BV, candida
Endocervical charcoal - gonorrhoea
Endocervical white - chlamydia

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5
Q

Cervical ectropian

A

Extension of endocervical epithelium to squamous epithelium
Pregancy, pill, puberty
Sx: asymptomatic, post-coital bleeding, inc discharge
At inc risk of HPV&raquo_space; do smear

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6
Q

Hysteroscopy

A

Safe and effective way of finding out the cause of:
Post-menopausal bleeding
Heavy periods
Small camera is used to look inside womb. Small tools can be used to remove polyps or fibroids. Can be done under GA or LA. Day case surgery.
Complications: failure, bleeding, infection, blood clot
Most people can return to normal activities next day

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7
Q

Fibroid

A

Muscle layer of womb becomes overgrown
Due to unopposed oestrogen
Inc urinary frequency, dyspareunia, menorrhagia

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8
Q

Polyp

A

Overgrowth of lining of womb

Looks like a grape on a stalk

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9
Q

HRT counselling

A
Reduction in oestrogen
45-55 y/o
Amennorhoea for 12 months
Sx:
Hot flushes
Mood swings
Vaginal dryness
Sleep problems
HOW BOTHERSOME ARE THESE SYMPTOMS?
Introduction of oestrogen should improve these symptoms
\+ red osteoporosis
\+ prevent #
- breast tenderness, inc appetite, weight gain
- breast & endometrial Ca
- DVT

Blood tests show inc FSH

With uterus: oestrogen & progesterone

Without uterus: oestrogen

Transdermal (weekly), oral (daily), pessary

Shortest period possible, no longer than 5 yrs, reduce slowly

CI: Breast Ca, active endometrial Ca, active VTE, active CVD

Other tx: SSRIs, complementary therapies, breast self exam, diet inc soy

Pre-menopausal: cyclical (bleeding)
Post-menopausal: continuous (avoid bleeding)

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10
Q

Endometriosis

A
Menorrhagia, dyspareunia, dysmenorrhea
Extrauterine tissue
Cyclical pain
Comp: IMB, subfertility, endo Ca
Mx:
- Mirena
- Tranexamic acid & Mefanamic acid
- Surgical removal
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11
Q

PCOS

A

Raised LH
FH, hirsutism, weight gain, lighter/no periods, acne, mood
Ix: bloods, TVUSS
>12 cysts, oligomenorrhoea, hyperadrogenism
Mx:
- exercise & weight to minimise CV / DM risk factors
- Metformin
- COCP, mirena
Comp: Endo Ca, CVD & DM, pregnancy issues due to sub-fertility

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12
Q

Menorrhagia history

A
Ask: LMP, length of periods, regular? 
Tampons & pads together?
Clots?
FH: endometriosis, blood disorders
SH: smoking, alcohol, drugs
MH: blood thinners, contraception 
DDX: SOB,energy levels, STI, pregnant? 
Weight loss, night sweats
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13
Q

Mennorhagia differentials

A
Hypothyroidism
2' to contraception or blood thinners
Bleeding disorder
Endometrial Ca
Ectopic pregnancy 
Fibroids
PID
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14
Q

Right shoulder tip pain (acute station)

A

Ectopic pregnancy

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15
Q

Amenorrhoae possible causes

A

Cerebral - stress, starvation, anorexia, exercise
HPA axis - prolactinoma
Thyroid - hypo/hyperthyroidism
Adrenal - cushings, androgen secreting tumour
Ovary - PCOS, premature menopause
Vaginal - pregnancy

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16
Q

Ashermans syndrome

A

Abortions
Amenorrhea
Adhesions

17
Q

Borderline or mild dyskariosis

A

HPV test
If +ve have colpsocopy with 12 month cytology review
If -ve will return to normal screening (3-5 years)

18
Q

Moderate or severe dyskariosis

A

Colposcopy
6 month cytology
If borderline or mild > HPV test
If moderate or severe > colposcopy

19
Q

Counselling mod-severe dyskariosis

A

Changes in the cells are normally caused by HPV.
Even with mod-severe changes, it is unlikely that you have cancer. However, it is unlikely that these abnormal cells will return to normal without treatment. It is important that we check these changes now so to prevent any serious changes in the future.

20
Q

Urge incontinence

A

Detrusor muscle instability
Sudden uncontrollable urge to urinate
Cause: nerve injury, MS, Dm, stroke
Mx: bladder training & pelvic floor esercises, oxybutynin (muscle relaxant)

21
Q

Stress incontinence

A

Sphincter - supported by pelvic floor muscles
Pelvic floor muscles weakened
Causes: age, obesity, pregnancy, VB
Mx: pelvic floor muscle exercises