Brainscape's Knowledge GenomeTM

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


See full index

OBS GYNAE > Gynae > Flashcards

Gynae Flashcards

1
Q

What are some common causes of intermenstrual bleeding?

A

Physiological - hormonal fluctuation around menopause
Vaginal - vaginitis
Cervical - STI, ectropion, polyps, cancer
Uterine - fibroids, polyps, cancer, endometriosis
Iatrogenic - missed pill, post-smear

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

Define a ‘complete’ abortion and its clinical features

A
  • Complete evacuation of all POC
  • Some light bleeding and minimal pain
  • Os remains closed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define an ‘incomplete’ abortion and its clinical features

A
  • Incomplete evacuation of POC
  • Heavier bleeding
  • Os is dilated, can be obstructed with POC
  • Uterus is small
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define a ‘missed’ abortion and its clinical features

A
  • Foetus has died but there have been no signs
  • Pregnancy continues but not with normal growth
  • Occurs <20weeks
  • Light bleeding, loss of symptoms of pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define a ‘threatened’ abortion and its clinical features

A
  • Clinical symptoms of miscarriage (bleeding and pain) but cervix is closed
  • Light bleeding, minimal pain
  • Size of uterus consistent with pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define a ‘inevitable’ abortion and its clinical features

A
  • Continuation of threatened abortion (miscarriage basically)
  • Painful contractions
  • Heavier bleeding, may have clots
  • Cervix is open
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define an ‘septic’ abortion and its clinical features

A
  • Infection of retained POC or damage caused during TOP
  • Fever, bleeding, pain
  • “Boggy” uterus
  • Cervix is open
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some causes of spontaneous abortion?

A
  1. Chromosomal abnormalities
  2. Anatomical uterine defects (congenital or acquired (fibroids, adhesions))
  3. Systemic disease (thyroid dysfunction, diabetes, PCOS)
  4. Iatrogenic
  5. Trauma (CVS, amniocentesis)
  6. Infection
  7. Thrombophillia
  8. Cervical incompetence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the definition of spontaneous abortion and how is it monitored?

A
  • Expulsion of products of conception before viability
  • <20 weeks or <400g
  • Monitor with daily hCG assays
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is cervical incompetence and how is it managed?

A
  • Abnormal weakness of cervix causing painless dilation during pregnancy
  • As intrauterine pressure increases –> membranes rupture –> miscarriage
  • Manage using cervical circlage at internal os, non-absorbable stitch
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How are spontaneous abortions managed?

A
  • Take daily hCG to determine non-progression of pregnancy
  • Surgical: dilatation and curettage or suction under U/S
  • Medical: misoprostol (PGE1)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some signs on U/S of poor prognosis that may result in miscarriage?

A
  • FHR <100 (50% demise), <85 (100% demise)
  • Sac size <5mm
  • Subchorionic haematoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why should CA125 NOT be used as a screening tool for ovarian cancer?

A
  • It is elevated in normal menstruation, ovarian cysts, endometriosis
  • It is not raised in up to 50% of women who DO have ovarian cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some risk factors for ectopic pregnancy?

A 
Previous ectopic
Chronic salpingitis
PID
STI
IUD
Tubal surgery
Most happen in patients with NO risk factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the important clinical features of ectopic pregnancy?

A

Sudden onset, severe, stabbing abdo pain
Nausea +/- vomiting
Rupture: tachy, hypotensive, peritonitis, shoulder tip pain

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

How does B-HCG change with a viable pregnancy?

A

Should double every 48hrs

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

What are the management options for ectopic pregnancy?

A
  1. Watchful waiting if caught early
  2. Pharmacologic: methotrexate
    - Inhibit folic acid synthesis –> inhibit rapidly dividing cells –> stop growth of embryo
  3. Surgical: salpingectomy or salpingostomy (partial removal)
    - Laparoscopic or laparotomy

**Serial HCGs until gone

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

What are the complications of ectopic pregnancy?

A
  • Persistent ectopic
  • Rupture
  • Recurrence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where can ectopic pregnancies reside?

A

95% in fallopian tube, most commonly ampulla
Abdo cavity
Cervix
Ovaries

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

What investigations are required for suspected ectopic?

A
  • Positive pregnancy test (serum beta HCG)
  • Ultrasound - transvaginal –> no intrauterine pregnancy detected (can sometimes visualise ectopic gestation sac)
    • Intrauterine pregnancy excludes diagnosis
  • Serum progesterone
  • FBC (infection, anaemia)
  • LFTs (biliary colic), EUCs (kidney stones)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does pregnancy look like on ultrasound?

A

True gestational sac - double echogenic ring
- Present 4.5-5.5 weeks
Yolk sac is present up to 10 weeks
Cardiac viability at 5.5-6 weeks

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

What are the 3 characteristics of PCOS?

A
  1. Signs of cysts (follicles) on ovaries (identified on U/S)
    - 12 or more, 2-9mm
  2. Hyperandrogenism
  3. Anovulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the basic pathophysiology of PCOS?

A

Insulin resistance –> hyperinsulinaemia –> increased androgen production

  • -> increased LH and decreased FSH –> poor follicular development (development of cysts) + anovulation
  • -> increased testosterone –> hyperandrogenism symptoms + prevents ovulation
  • -> poor follicular development –> no development of corpus luteum –> reduced progesterone and therefore increased unopposed estrogen –> increased endometrial cancer risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are some causes of amenorrhoea?

A 
Pregnancy, ectopic, molar
Contraception
Excessive exercise, very low BMI
PCOS
Menopause
Hyperprolactinaemia, breastfeeding
Hyper/hypothyroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What investigations are required for PCOS?

A 
Transvaginal ultrasound
BSL, OGTT
FBC
Lipid profile
TFTs
Free androgen index
Testosterone 
DHEAS
17-OH Progesterone (rule out adrenal hyperplasia)
Prolactin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the clinical features for PCOS?

A

Hyperandrogenism = acne, hirsuitism (hair on face, arms, back, linea alba, chest)
Central obesity
Anovulation (infertility)
Menstrual irregularity, menorrhagia/oligomenorrhoea
- Insulin resistance, hyperlipidaemia
- Cysts on ovaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the treatment options for PCOS?

A

Weight loss
Add metformin if appropriate
Fertility: clomifene (stimulates follicular development)
Non-fertility: OCP, antiandrogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the mechanism of action of 5a reductase inhibitors? What are they used for?

A

Prevents conversion of testosterone into DHT - precursor to other androgens)
PCOS
- Antiandrogen
BPH
- reduce prostate size (DHT promotes growth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the theories for the pathophysiology of endometriosis?

A
  1. Retrograde menstruation: flow of menses back through fallopian tubes to abdo cavity, does not account for distal sites of endometrium (e.g. lung)
  2. Coeliomic metaplasia: metaplasia of peritoneal mesothelium into endometrium
  3. Induction theory: Differentiation of undifferentiated peritoneal cells into endometrial tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the features on history and examination for a diagnosis of endometriosis?

A
  1. Dysmenorrhoea
  2. Dyspareunia
  3. Dysuria
  4. Dyschezia
  5. Dolor (chronic pelvic pain)
    Exam: PV exam - fixed adnexal mass (endometrioma), nodules over uterosacral ligaments and POD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the 3 different kinds of endometriosis?

A

Superficial peritoneal endometriosis = white plaques/scarring on ovaries, peritoneum (can also be red)
Endometrioma (chocolate cyst) = contain thick fluid, densley adherent to peritoneum on ovarian fossa
Deep infiltrating endometriosis = nodules extend >5mm below surface of peritoneum –> affects bladder, bowel, vagina, ureters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the treatment options for endometriosis?

A

Analgesia: NSAIDs, panadol
COCP - suppress HPO axis –> reduce E/P secretion –> atrophy of ectopic implants, skip periods (avoid pain)
GnRH agonists –> as above
Surgery - remove ectopic endometrial lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Compare and contrast complete and partial hyatidiform moles

A

COMPLETE: Fertilisation of egg without a nucleus –> entirely paternal information

  • No fetus present
  • VERY high B-HCG
  • Multi-vascular mass of trophoblastic tissue and hydropic change

PARTIAL: Fertilisation of normal egg with 2 sperm –> triploidy

  • (usually) Non-viable fetus present
  • B-HCG can be normal
  • Some proliferation and hydropic change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is gestational trophoblastic disease?

A

Tumours of fetal tissue, represents failure of embryogenesis

- Includes benign trophoblastic tumours, hyatidiform moles, neoplasia (e.g. choriocarcinoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is a choriocarcinoma?

A

Tumour of trophoblastic cells –> secrete HCG

- Occur when molar pregnancies do not regress after surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are hyatidiform moles?

A

Chromosomally abnormal pregnancies that have potential to become malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How do complete and partial hyatidiform moles differ on ultrasound?

A

COMPLETE

  • No fetus present
  • Entire uterus is filled with ‘moles’ - looks like grapes

PARTIAL

  • Non-viable fetus is visible
  • Uterus partially filled with grapes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What investigations need to be performed when expecting a molar pregnancy?

A 
Trans-vaginal ultrasound
B-HCG - weekly
FBC (anaemia), blood group and Rh, group and hold
TFTs
Histological examination of endometrium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How long must B-HCG monitoring continue after molar pregnancy?

A

Until negative for 3 consecutive weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the treatment options for molar pregnancies?

A

Fertility: D&C, methotrexate (if persistent GTN after molar pregnancy)
Non-fertility: Hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are some complications of GTD?

A 
Hyperemesis gravidarum, thyrotoxicosis
Active bleeding
Pre-eclampsia
Asherman's syndrome post-D&amp;C
Choriocarcinoma
Metastases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the clinical features that make you think molar pregnancy?

A 
PV bleeding
Pelvic pain/pressure
VERY high levels of B-HCG
Hyperemesis gravidarum
Uterus palpated at greater than dates
Pre-eclampsia, hyperthyroidism, anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are some differentials for a large uterus?

A

Twins
Wrong dates
Fibroids
Molar pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the triad of symptoms to look for with adenomyosis?

A
  1. Menorrhagia
  2. Dysmenorrhoea
    - Often post-menopausal bleeding
  3. Dyspareunia
    +
    Symmetrically bulky uterus on exam
    Usually occurring in older women
45
Q

How do you define adenomysosis?

A

Ectopic endometrium implanting into the myometrium

46
Q

What is a fibroid? What are the different types?

A

Leiomyoma - benign tumour of the smooth muscle cells of the uterus
Submucosal - under endometrial lining growing into the uterine cavity
Intramural - within uterine wall
Subserosal - underneath uterine serosa, can grow outwards and pedunculate into abdo cavity

47
Q

How does fibroid present on examination? What investigations are required?

A

Asymmetrically bulky uterus, firm and non-tender, large for dates if pregnant
Pelvic ultrasound, endometrial biopsy

48
Q

What are the other clinical features of fibroids?

A

Menorrhagia, dysmenorrhoea, signs of anaemia
Pelvic mass - can press on ureters (LUTS)
Subfertility (esp submucosal)
Pelvic pain

49
Q

What are the treatment options for fibroids?

A

Desiring fertility:

  • IUD
  • Surgical: Transcervical resection of fibroids (TCRF), Myomectomy (pre-surgical GnRH agonist will shrink fibroid before surgery)

Do not desire fertility

  • Uterine artery embolism
  • Myomectomy
  • Hysterecomy
50
Q

What are some differentials for a central pelvic mass?

A 
Pregnancy
Molar pregnancy
Fibroids
Endometrial cancer
Adenomyosis
Bladder cancer or normal full bladder!
GIT - stool, inflammatory abscesses
51
Q

What are some differentials for a lateral pelvic mass?

A 
Ovarian cyst
Pedunculated fibroid
Ovarian cancer
Endometrioma (chocolate cyst)
Theca lutein cyst
Pelvic kidney
PID with tubo-ovarian abscess
Ectopic pregnancy
GIT (appendicitis, Crohn's, diverticula, GI cancer)
52
Q

What are the different kinds of prolapse?

A 
Rectocele - prolapse of rectum/large bowel
Cystocele - prolapse of bladder
Enterocele - prolapse of small bowel
Uterine prolapse
Vaginal vault prolapse
53
Q

What are some risk factors for prolapse?

A

Any factors that weaken / damage the normal pelvic support system can lead to prolapse and urinary stress incontinence

  • Childbirth (macrosomy, episiotomy, forceps)
  • Hysterectomy
  • Connective tissue defects (Ehler’s Danlos)
  • Factors that put STRESS on pelvic floor (prolonged physical labour, constipation, COPD, obesity)
  • Postmenopausal atrophy (less vascularised)
54
Q

Briefly explain the pathogenesis of prolapse

A

Stress and straining
Bony pelvis, Broad ligament, Uterosacral and cardinal lig, Urogenital diaphragm, Pelvic diaphragm (levator ani), Perineum
- Rupture of these ligaments
- Stretching of fascia
- Weakening of connective tissues
Loosens the ‘hammock’ of muscles making up the pelvic floor that hold up the bladder, pelvic structures, etc.

55
Q

What are the common symptoms of prolapse?

A 
Asymptomatic
Feeling of heaviness in vagina/rectum
Dyspareunia
Pain at end of day
Straining with incomplete evacuation, may need to use fingers to help
Feeling as though there is a mass present 
Dysuria / dyschezia / incontinence
Visually observing the prolapse
56
Q

What are the management options for prolapse?

A

Non-surgical: pessaries, physio for pelvic floor strengthening, topical estrogen
Surgical: using a mesh to reattach

57
Q

What are the options for emergency contraception?

A
  1. Progesterone-only ‘morning after pill’ (3 days)

2. Copper IUD (5 days)

58
Q

How do hormonal contraceptives work?

A
  1. Prevent ovulation through disruption of hypothalamic-pituitary-ovarian axis (inhibit FSH and LH release)
  2. Thicken cervical mucus
  3. Endometrial atrophy
59
Q

What is the definition of infertility?

A

Failure to conceive after 12 months of consistent unprotected sex

  • Primary - no other pregnancies
  • Secondary - other successful pregnancies
60
Q

What are some male factors causing infertility?

A

Azoospermia
Low sperm count
○ Seminiferous tubule dysfunction (60-80%)
○ Post-testicular defects -disorder of sperm transport (10-20%)
○ Primary hypogonadism (10-15%)
○ Hypothalamic pituitary disease -secondary hypogonadism (1-2%)

Previous infection - orchitis, mumps
Radiation exposure - testicular cancer, leukaemia
CBAVD
Smoking, alcohol, obesity

61
Q

What are some female factors causing infertility?

A

Ovulatory dysfunction
- Increasing age - decreasing egg number and viability, PCOS
Tubal disease - STI causing salpingitis and scarring
Anatomical
- Congenital: uterine didelphys, bicornate, septate
- Acquired: tubal surgery, submucosal / large intramural fibroids, Asherman’s
Unexplained
Smoking, alcohol, obesity

62
Q

What is the definition of subfertility?

A

Failure to conceive after 2 years of regular unprotected sex AND despite normal investigations

63
Q

What is fecundity? How does it change over time?

A

Potential reproductive capacity of an individual
- Females per month change of conception:
○ Age 21 = 25% chance (peak)
○ Age 35 = 12%
○ Age 40 = <5%
- Males is consistent over time

64
Q

What questions are required for the male on a fertility history?

A 
- Developmental history
	• Testicular descent
	• Pubertal development
	• Loss of body hair
	• Decrease in shaving history
- Chronic medical illness
- Infections
	• Mumps orchitis
	• CF
	• STIs
	• UTIs
	• Prostatitis
- Surgical history
	• Vasectomy
	• Orchiectomy
Any children with another partner, any previous investigations
Smoking, alcohol, steroids, chemo
65
Q

What questions are required for the female on a fertility history?

A 
Full menstrual history history
Full obstetric history - any previous pregnancies/ miscarriages/ terminations
Sexual history and STIs
Contraceptive history 
Pap smears
Screen for PCOS symptoms
PMHx (tubal surgery, SLE, thyroid disorder, DM)
FHx (infertility, chromosomal disorders)
66
Q

What investigations are required for infertility?

A

Male:

  • Sperm sampling
  • Bloods: FSH, LH, PRL, testosterone, anti-sperm antibodies

Female:

  • Bloods: FBC, coags, LSH, FSH, TSH, testosterone, DHEAS, lipid profile, HbA1c
  • Rubella screen
  • Imaging: TV ultrasound

*Karyotype for both

67
Q

Describe the differences in appearance of cervical os in nulliparous and parous women.

A

Nulliparous
- Barrel shaped, small circular external os
Multiparous
- Cervix is bulky and external os looks like a slit

68
Q

What is a cervical ectropion?

A

Where the endocervical columnar epithelium extends out through external os –> undergoes squamous metaplasia –> becomes stratified squamous epithelium
- Common with OCP

69
Q

What are the different types of HPV? Which ones cause which kinds of warts?

A 
- HPV
	○ Cancer 16, 18
	○ Genital warts 6, 11
		○ These 4 covered by gardasil vaccination
	○ Other warts 1, 2
70
Q

What is CIN? How is it detected?

A 
Cervical intraepithelial neoplasia (pre-invasive lesion)
Need cytological investigation
○ CIN 1
	§ Mild dysplasia
	§ Affects lower 1/3 of epithelium
○ CIN 2
	§ Moderate dysplasia
	§ Lower 2/3
○ CIN 3
	§ Severe dysplasia
	§ Full thickness
	§ Carcinoma in situ
If they invade through BM --> cervical cancer
71
Q

Explain pathway for pap smear results

A

CIN1/low-grade changes –> repeat in 12mo
○ –> CIN1 again –> culposcopy
○ normal –> repeat 12mo
○ –> normal –> 2 yearly
○ –> CIN1 again –> culposcopy
CIN2-3/high-grade changes –> straight to culposcopy

72
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma is the most common type of cervical cancer

73
Q

Which cells are being sampled on a pap smear?

A

Cells from transformation zone

Glandular –> transformation –> squamous

74
Q

What kind of prolapse commonly occurs following hysterectomy?

A

Vaginal vault prolapse commonly occurs following a hysterectomy (removal of the uterus (womb)). Because the uterus provides support for the top of the vagina, this condition occurs in up to 40% of women after a hysterectomy.

75
Q

What are the 6 anatomical systems required for pelvic support?

A 
Six different systems: BBUUPP
1• Bony Pelvis
2• Broad Ligaments
3•Cardinal and Uterosacral Ligaments.
4• Urogenital Diaphragm.
5• Pelvic Diaphragm including Levator Ani Muscles.
6• Perineum including the Perineal Body
76
Q

What is a cystocele?

A

Protrusion of the bladder into the vagina due to defects in pelvic support.
The bladder base descends below the inferior ramus of the symphysis pubis at rest or with straining.

77
Q

What are the grades of cystocele?

A
  1. Descending towards introitus with straining
  2. Descends to level of introitus with straining
  3. Descends outside of introitus with straining
  4. Outside of introitus at rest
78
Q

What is an enterocele?

A

An enterocele is essentially a vaginal hernia in which the peritoneal sac containing a portion of the small bowel extends into the rectovaginal space.

79
Q

What surgery is used to treat vaginal vault prolapse?

A

The McColl procedure

It is the re-approximation of the Cardinal and Uterosacral ligaments to the vaginal apex

80
Q

Why does prolapse cause incontinence?

A
  • If patient coughs (applies pressure) urethra pushed downwards from pressure
    ○ Comes against resistance of hammock
    ○ Occludes the urethra
  • If suspension system is ruptured, when apply pressure (jump, cough, etc.)
    ○ Urethra goes down and nothing to support hammock
    ○ Urethra does not collapse –> few drops come out
81
Q

What are some contraindications to taking the oral contraceptive pill?

A

DVT/PE, migraines, breast cancer history, pro-thrombotic disorders, poor compliance issues, CV risk factors (HTN, DM, arterial disease), hepatic impairment, BMI >35

82
Q

Describe the differences in discharge between bacterial vaginosis, candidiasis, chlamydia, trichomoniasis

A

Bacterial vaginosis: thin white/grey/green, strong fishy odour
Candida/thrush: thick white, cheesy, usually odourless
Chlamydia: yellow mucopurulent
Trichomoniasis: grey frothy, can be fishy

83
Q

What kind of cells are present in microscopic investigation of bacterial vaginosis discharge?

A

Clue cells

84
Q

What are you measuring on TV U/S when looking for adenomyosis?

A

Junctional zone between endometrium and myometrium is >12mm

85
Q

How does an endometrioma appear on ultrasound?

A

Large complex ovarian cyst

Ground glass appearance but homogenous

86
Q

What is the best way to remove a large ovarian cyst?

A

Best way is vaginal hysterectomy, also consider laparoscopic and abdominal
- may be too big

87
Q

What is the differente between total and subtotal hysterectomy?

A

Total = remove cervix
with or without bilateral salpingo-oopherectomy (= radial hysterectomy)
Subtotal = leave cervix

88
Q

What is the most common presentation for a polyp?

A

IMB, any time in cycle, lighter than period, no pain, sometimes post-coital, normal smears

89
Q

What is the classic appearance of polyp on ultrasound?

A

Hyperechoic mass with feeder vessel
- Looks like a chickpea
Myometrial growth depends on cycle - changes the echogenicity

90
Q

What is the gold standard treatment for polyps?

A

Hysteroscopy, polypectomy under direct visual guidance (no dilation required)
- If polyp is too big can cut up and remove in smaller pieces

91
Q

What is the definition of dysfunctional uterine bleeding?

A

Excessive bleeding not due to pregnancy, pelvic pathology or systemic disease

92
Q

What is the best treatment for dysfunctional uterine bleeding?

A

Not desiring fertility: ablation of endometrial lining

- Always do hysteroscopy first before burning to sample and make sure not cancer

93
Q

What is the best way to diagnose endometrial cancer?

A

Ultrasound - thickness >5mm
Hysteroscopy and curettage
- Looks fluffy and vascularised

94
Q

How do overweight women end up with increased endometrial thickness?

A

Fat –> produces androgens –> estrogens –> promote growth of endometrium without the balance of progesterone (no longer ovulating)
○ Adipose hyperandrogenism
○ Usually just hyperplasia BUT can be bad times

95
Q

What are the choices of treatment for endometrial cancer?

A
  1. Hormonotherapy with mirena (good if cannot operate or young, still need hysteroscopy and curettage every 3 mo)
  2. Radiotherapy
  3. Total hysterectomy with BSO and lymphadenectomy
96
Q

What is the treatment for cervical cancer?

A

Radial hysterectomy

- Uterus, cervix, parametrium, top of vagina

97
Q

What are the risk factors for endometrial cancer?

A 
Post-menopausal
Nulliparous
Obesity
Unopposed estrogen (HRT)
Lynch syndrome 
PCOS
98
Q

What is the treatment for fibroids? What is a complication?

A

Hysteroscopic resection

TURP syndrome - reabsorbing too much glycine causing a hyponatraemia

99
Q

What are the risks of a laparoscopic myomectomy?

A

A. Transfusion - bleeds more than hysterectomy
B. Rupture of uterus- big scar on uterus, if become pregnant, do not let them labour, prophylactic caesar
C. Adhesions - use anti-adhesion fluid on the scar
D. Spreading of cancer - the instrument propel little bits of cancer everywhere
E. Incisional hernia

100
Q

What is the antibiotic treatment for gonorrhoea?

A

Ceftriaxone 125mg IMI

Doxycycline 100mg bd orally for 7 days treats Chlamydia which is frequently also present

101
Q

What is PID

A

PID refers to acute infection of the upper genital tract structures in women, involving any or all of the uterus, oviducts, and ovaries and sometimes other surrounding pelvic organs

102
Q

How do you diagnose PID?

A

Clinical diagnosis:

- Pelvic pain + cervical motion / adnexal tenderness + risk factors, fever, positive cultures, inflammatory mass on U/A

103
Q

How does PID present?

A

Risk factors: young, multiple sex partners, previous STI, TOP
Symptoms: recent onset, usually constant & aching, bilateral, post-coital bleeding
Exam: cervical motion tenderness, adnexal tenderness, cervical mucopurulent discharge on spec

104
Q

What investigations are required for PID?

A

Pregnancy test
Microscopy of vaginal discharge
NAATs chlamydia, gonorrhoea, M. genitalium
HIV screening
Syphilis serology
Can consider ultrasound to rule out other pelvic pathology causing s

105
Q

What is the treatment for chlamydia?

A

Azithromycin 1g PO STAT

106
Q

What is the treatment for gonorrhoea?

A

Ceftriaxone 500mg IMI STAT

usually also give azithromycin 1g PO STAT

107
Q

What is the treatment for genital herpes?

A

Initial episode: 500mg valcyclovir PO daily for 5-10 days
Following episodes: 3 days
Preventative: daily therapy for 6 months

108
Q

What are the complications of PID?

A

TOA, TOA rupture
Fitz Hugh Curtis syndrome
Infertility, ectopic

OBS GYNAE (2 decks)

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