Gynae Flashcards
definition of acute pelvic infection
STI affecting pelvic organs including uterus, fallopian tubes and ovaries
what causes PID
ascending infections from vagina and cervix sexually transmitted, or iatrogenically from resident bacteria through instrumentation and procedures
what is perihepatitis
infection/adhesions between uterus and liver, causing RUQ pain
clinical features of PID
asymptomatic bilateral lower abdominal pain deep dyspareunia vagina discharge bleeding
examination findings of PID
tachycardia in severe pyrexia lower abdominal peritonism bilateral adnexal tenderness cervix excitation palpable abscess
differential diagnoses of PID
appendicities ovarian cyst accidents (unilateral pain) ectopic pregnancy (+ve pregnancy test and unilateral pain)
how to investigate PID
endocervical swabs for chlamydia and gonorrhea
blood cultures
WBC, CRP
pelvic US to exclude abscess/cyst
laparoscopy with fimbrial biopsy is diagnostic
what is diagnostic for PID
laparoscopy with fimbrial biopsy is diagnostic
how to treat PID
analgesics
antibiotics
complications of PID on fertility
reduced fertility
increased ectopic risk
What is the definition of menopause
12 months after cessation of menstrual bleeding
What is the definition of perimenopausal
Someone with the symptoms of menopause but still bleeding, albeit intermittently
What is the median age for menopause
51
What is the definition for premature menopause
Before 40
What is the definition of postmenopausal bleeding
Any bleeding that occurs after menopause
What can cause PMB
endometrial cancer endometrial hyperplasia cervical cancer endometrial or cervical polyps Withdrawal bleed during sequential HRT Atrophic vaginitis Cervicitis
How is atrophic vaginitis diagnosed
Diagnosis of exclusion after investigating for malignancy, masses, cysts, hyperplasia
How is PMB investigated (1st, 2nd, 3rd line)
Speculum, smear, bimanual
TVUS - endometrial thickness, masses
Hysteroscopy + biopsy
What does TVUS look for in PMB investigation
Thickness of endometrium and any masses, or cysts
What thickness is abnormal in postmenopausal endometriums
> 4mm
What can a mass seen during TVUS in PMB bleed be?
Fibroid, polyp, cyst
When should hysteroscopy and biopsis be done in PMB investigation
If endometrial lining is >4mm
What are some vasomotor symptoms of menopause
Hot flushes, night sweats
What are some urogenital symptoms in menopause
Itchy, dry, burning, dyspareunia,
Frequency, urgency, nocturia, incontinence, recurrent UTIs
What sexual problems occur in menopause
Loss of desire
Loss of arousal
Pain during sex
Loss of ability to achieve orgasms
What are risk factors for osteoporosis
Family hx Low bmi Smoking/alcohol Early menopause Low calcium intake Sedantary lifestyle Long term corticosteroid use Other bone homeostasis disrupting diseases
What blood markers are useful in investigating menopause
FSH, AMH
High FSH and low AMH is typical in menopause
Biochemical markers in blood are not used for diagnosis osteoporosis - t or f
True
What is the HRT regiment for someone without a uterus
Continuous oestrogen
Why is progesterone required in HRT for women with uteruses
To prevent endometrial hyperplasia
What happens in unopposed oestrogen therapy?
Increased endometrial cancer risk.
What is the regime of HRT for perimenopausal women with uterus
Estrogen + progesterone either combined daily or sequentially.
What is the regime for postmenopausal women with uterus
Combined estrogen and progesterone, can be given in IUS
Benefits and risks of HRT
Benefits: reduces symptoms, reduces osteoporosis and colorectal cancer
Risks: increases breast cancer risk, VTE and gallbladder diseases.
How long is HRT regime stayed on for
5 years for perimenopausal women and then review on needs
Postmenopausal for osteoporosis risk - life long
Premature menopausal women - till median menopause age and then reviewed on needs
What non-hormonal medication can be given to reduce osteoporosis
Biphosphonates
what are 5 ways of assisted conception
IUI IVF ICSI oocyte donation surrogacy
when is an ovarian cyst significant or insignificant
if premenopausal: >55mm is significant
if postmenopausal: any sized cyst is significant
5 common types of ovarian cancer
serous cystadenoma endometroid carcinoma mucinous cystadenoma clear cell carcinoma others
is PID pain unilateral or bilateral?
bilateral
what is color discharge is characteristic of vaginosis?
grey watery discharge
what is purulent vaginal discharge suggestive of?
gonorrhea, PID
what color discharge is chlamydia?
yellow or milky white
what causes a chracteristic cottage cheese discharge?
candida
symptoms of ovarian cancer
abdominal bloating and/or distension
urinary frequency
weight loss
symptoms of endometrial cancer
post coital bleeding
post menopausal bleeding
pelvic pain
most common cause of PMB?
vaginal atrophy
