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Medicine > Gynae > Flashcards

Gynae Flashcards

1
Q

HRT types

A

oesetrogen + progesterone or oestrogen only

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2
Q

oesetrogen + progesterone or oestrogen only

A

types of HRT

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3
Q

risks of oestrogen only HRT

A

endometrial hyperplasia –> endometrial cancer

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4
Q

endometrial hyperplasia –> endometrial cancer

A

risk of oestrogen only HRT

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5
Q

risks of any HRT

A

increased VTE risk in 1st 6/12, increased breast cancer risk after 5 years of treatment

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6
Q

increased VTE risk in 1st 6/12, increased breast cancer risk after 5 years of treatment

A

risks of any HRT

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7
Q

premature ovarian failure

A

cessation of mentruation for 1 year before 40 years old

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8
Q

cessation of mentruation for 1 year before 40 years old

A

premature ovarian failure

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9
Q

menstrual phase occurs becuase

A

no ovum has been fertilised, corpus luteum breaks down, therefore cessaton of progesterone production, vasoconstriction of spiral arteries which supply the functional layer of the endometrium, layer necroses + is shed

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10
Q

pulsing of what hormone initiates puberty

A

GnRH

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11
Q

GnRH pulsation initiates

A

puberty

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12
Q

ovarian hyperstimulation S

A

associated with HCG in maturing follicles during IVF, lower abdo discomfort, N, V, abdo distension

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13
Q

associated with HCG in maturing follicles during IVF, lower abdo discomfort, N, V, abdo distension

A

ovarian hyperstimulation S

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14
Q

1’ amenorrhoea causes

A

Turner’s S, testicular feminisation, congenital adrenal hyperplasia, congenital malformation of the genital tract

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15
Q

Turner’s S, testicular feminisation, congenital adrenal hyperplasia, congenital malformation of the genital tract are causes of

A

1’ amenorrhoea

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16
Q

2’ amenorrhoea causes

A 
periods stop for >6/12
hypothalamic amenorrhoea (stress, excessive exercise), PCOS, hyperprolactinaemia, premature ovarian failure, thyrotoxicosis, Sheehan S (hypopituitarism), Asherman S (intrauterine adhesions)
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17
Q

hypothalamic amenorrhoea (stress, excessive exercise), PCOS, hyperprolactinaemia, premature ovarian failure, thyrotoxicosis, Sheehan S (hypopituitarism), Asherman S (intrauterine adhesions) are causes of

A

2’ amenorrhoea

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18
Q

mittelschmerz is

A

mid cycle pain, sharp

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19
Q

endometriosis is

A

growth of ectopic endometrial tissue o/s of the uterine cavity, ?initiate by retrograde menstruation spreading endometrical cells w/i the pelvis

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20
Q

ovarian torsion is

A

sudden onset, deep colicy pain, V, distress

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21
Q

pelvic pain differentials

A

endometriosis, PID, migraine, lower back pain, adenomyosis, adhesions, ectopic, ovarian torsion, appendicitis, IBS, cystitis, depression, sleep disorders, abuse (past + present)

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22
Q

amenorrhoea differentials

A

1’: delayed puberty, PCOS, Turner’s S, imperforated hymen, transverse vaginal septum
2’: pregnancy, menopause, lactation, iatrogenic (progestogens, GNRH analogues, some antipsychotics), premature menopause, PCOS, hyperprolactinaemia (pituitary hyperplasia, benign adenoma), hypothalamic hypogonadism (low BMI, excessive exercise, tumour), thyroid dysfunction

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23
Q

dysmenorrhoea differentials

A

idiopathic (common), fibroids, adenomyosis, endometriosis, PID, ovarian tumours

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24
Q

menorrhagia differentials

A

subjective to PTs beliefs, idiopathic, fibroids, polyps, coagulopathy, adenomyosis, malignancy

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25
Q

PCB differentials

A

cervical ectropion, polyps, CIN, cervicitis, vaginitis

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26
Q

infertility differentials

A

female factors: ovulation (PCOS, hypothalamic hypogonadism, hyperprolactinaemia, premature ovarian faliure), fallopian tube (PID, endometriosis, previous Sx), cervical, implantation
male factors: sperm numbers, motility, morphology (smoking, EtOH, drugs, chemical exposure, genetics, idiopathic)
both: sexual (ED, dyspareunia)

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27
Q

PMB differentials

A

endometrial cancer, cervical cancer, premalignant endometrial hyperplasia, sequential HRT, atrophic vaginitis, polyps, cervicitis, ovarian carcinoma

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28
Q

IMB differentials

A

anovulatory cycles, fibroids, polyps, adenomyosis, ovarian cysts, chronic pelvic infection, STI, miscarriage

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29
Q

oligomenorrhoea

A

infrequent periods -/- 35/7-6/12 between periods

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30
Q

PMB is

A

bleeding 1 year post-menopause

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31
Q

menorrhagia history

A

menstrual calendar, flooding, clots, IMB, PCB, dysmenorrhoea, bleeding from elsewhere (PR), contraception use

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32
Q

menorrhagia O/E

A

anaemia, enlarged uterus - fibroids, tenderness - adenomyosis

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33
Q

adenomyosis is

A

endometruim breaks through the myometrium of uterus leading to cramps, menorrhagia, abdominal pressure and bloating

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34
Q

endometruim breaks through the myometrium of uterus leading to cramps, menorrhagia, abdominal pressure and bloating

A

adenomyosis

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35
Q

menorrhagia investigations

A

FBC, clotting, TFT, TVUS, hysteroscopy, biopsy

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36
Q

menorrhagia management

A

mirena coil (IUS), tranexamic acid (just during menstruation), mefanamic acid (NSAID), COCP, progestogens (high does/IM), GNRH agalogues (reduce size of fibroid), surgery: polyp removal, endometrial ablation, rescection (fibroids), myomectomy (fibroids), hysterectomy, uterine artery embolisation

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37
Q

TVUS uterus wall thickness “too thick”

A

> 10mm premenopausal, >4mm postmenopausal

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38
Q

IMB investigations

A

if appropriate: FBC, urine dip, STI screen, TVUS, hysteroscopy, biopsy

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39
Q

IMB management

A

IUS, COCP, high dose progestogen, HRT, surgery

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40
Q

amenorrhoea management

A

supportive, COCP, HRT, correcting organic cause

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41
Q

PCB investigations

A

speculum, smear, colposcopy if necessary

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42
Q

PCB management

A

polyp: avulsion, ectropion: frozen, LLETZ if appropriate etc

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43
Q

dysmenorrhoea is

A

painful periods, associated with high prostaglandin levels due to contraction + uterine ischaemia

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44
Q

dysmenorrhoea history

A

where in cycle?, relieved by menstruation?, dyspareunia, menorrhagia, oligomenorrhoea, PCB, IMB, STI Hx

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45
Q

dysmenorrhoea management

A

NSAIDs, COCP, reassurance in idiopathic, treat cause in pathology

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46
Q

subfertility definition

A

failure to conceive after 1y of regular unprotected sex

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47
Q

1’ vs 2’ subfertility/infertility

A

1’ means that the person has never conceived, 2’ means that the person had previously conceived (even if resulted in miscarriage)

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48
Q

infertililty investigations

A

serum progesterone (high mid-luteal = ovulation), TVUS, FSH (high in ovarian failure, low in hypothalamic DZ, N in PCOS), prolactin (prolactinoma), TSH, LH (high in PCOS), testosterone, semen analysis (repeat in 3/12), laproscopy + dye test, hysterosalpingogram

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49
Q

luteal phase is

A

14 days prior to menstruation e.g. days 14-28 of a 28d cycle

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50
Q

mid luteal phase is

A

day 21 of a 28 day cycle

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51
Q

infertility management

A

lifestyle changes, treat cause, induction of ovulation, IUI, ICSI as part of IVF cycle, counselling

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52
Q

complications of assisted conception

A

multiple pregnancies, ovarian hyperstimulation S, intraperitoneal haemorrhage, infection, ectopic, ch/genetic abnormalities

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53
Q

PMB investigations

A

bimanual, speculum, smear, TVUS, hysteroscopy, biopsies (Pipelle or during hysteroscopy)

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54
Q

gynae history

A

PC, HPC (menstruation: cycle l, ir/regular, heavy, painful, LMP, IMB, PCB, PMB, urinary: f, nocturia, urgency, accidents, associations, dysuria, haematuria, prolapse: heavy, dragging sensation, palpable mass), ICE, O+GH (smear, pregnancies, mode of delivery), sexual (active, discharge, dysuria, rash, dyspareunia), C, PMH, PSH, DH + A, SH, FH

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55
Q

pre-cancerous state in cervix

A

CIN cervical intraepithelial neoplasm

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56
Q

CIN cervical intraepithelial neoplasm

A

precancerous state in cervix

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57
Q

CIN is only diagnosable on

A

biopsy

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58
Q

explaining colposcopy

A

day case, Dr/nurse specialist, speculum, special misroscope (doesn’t enter vagina), stain, swab, biopsy (1/52 turnaround), 15-20 mins, can work same day, some bleeding/discharge 3-5/7, bring pad, avoid sex, tampons, pessaries, creams 24h beforehand + until bleeding stops

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59
Q

colposcopy biopsy result may result in

A

diathermy, laser, excision depending on result

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60
Q

complications of cervix treatment

A

premature labour - contact GP if get pregnant, ?cervical l scan

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61
Q

premature labour - contact GP if get pregnant, ?cervical l scan

A

complication of cervical treatment

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62
Q

most common type of primary ovarian cancer

A

epithelial cell carcinoma

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63
Q

grading of ovarian carcinoma

A

boarderline - high grade

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64
Q

most common type of primary ovarian cancer in <30 y.o.

A

germ cell tumour

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65
Q

risk factors for ovarian cancer

A

early menarche, late menopause, nulliparity, FH, benign cysts (can undergo malignant change), HNPCC, BRCA mutation

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66
Q

protective factors for ovarian cancer

A

pregnancy, lactation, COCP

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67
Q

epithelial cell carcinoma is the most common type of

A

ovarian cancer

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68
Q

germ cell tumour is the most common type of

A

ovarian cancer in >30 y.o.

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69
Q

early menarche, late menopause, nulliparity, FH, benign cysts (can undergo malignant change), HNPCC, BRCA mutation are risk factors for

A

ovarian cancer

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70
Q

pregnancy, lactation, COCP are protective factors for

A

ovarian cancer

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71
Q

ovariam cancer symptoms

A

persistent bloating, early satiety, LOA, pelvic/abdo pain, weight loss, fatigue, change in bowel habits, urinary f, urgency

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72
Q

persistent bloating, early satiety, LOA, pelvic/abdo pain, weight loss, fatigue, change in bowel habits, urinary f, urgency

A

ovarian ca

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73
Q

ovarian ca investigations

A

abdo examination, bimanual, CA125 (>50 y.o.), AFP + hCG (<40 y.o. - germ cell markers), TAUS

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74
Q

risk calculation in ovarian ca

A

RMI - risk of malignancy index

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75
Q

RMI

A

US score x menopausal state x CA125

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76
Q

US score features

A

multilobular cysts, solid areas, mets, ascites, bx lesions

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77
Q

RMI - risk of malignancy index

A

used in ovarian ca to decide whether to refer to specialist MDT

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78
Q

US score x menopausal state x CA125

A

RMI

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79
Q

multilobular cysts, solid areas, mets, ascites, bx lesions

A

features on TAUS that contribute 1 point to US score for RMI

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80
Q

ovarian ca management

A

Sx (TAH + BSO + partial omentectomy + LN biopsy/removal), potential for fertility-sparing Sx in boarderline DZ, chemo (carboplatin/cisplatin for high grade), follow up CA125, palliative care

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81
Q

ovarian ca staging

A

1 - ovaries only, 2 - pelvis only, 3 - abdo + pelvis, 4 - distant spread, inc liver

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82
Q

PMB must rule out

A

endometrial ca

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83
Q

endometrial ca risk factors

A

age (60 y.o.), nulliparity, unopposed oestrogen therapy (6x increase), early menarche, late menopause, obesity, DM, tamoxifen, PCOS, ovarian granulosa cell tumour (oestrogen secreting)

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84
Q

age, nulliparity, unopposed oestrogen therapy, early menarche, late menopause, obesity, DM, tamoxifen, PCOS are risk factors for

A

endometrial ca

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85
Q

after the menopause submucosal fibroids usually

A

calcify

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86
Q

calcification of which fibroids usually occurs after the menopause

A

submucosal

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87
Q

endometrial ca investigations

A

TVUS, measure thickness, hysteroscopy, biopsy, Pipelle biopsy, MRI, CXR

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88
Q

management of endometrial ca

A

TAH + BSO, post-op external beam radiotherapy in high risk DZ

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89
Q

vaginal atrophy presentation

A

dyspareunia, dryness, PCB

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90
Q

endometrial hyperplasia

A

abnormal proliferation of endometrium, presents with IMB, PMB, menorrhagia, irregular bleeding

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91
Q

rish factors for endometrial hyperplasia

A

obesity

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92
Q

abnormal proliferation of endometrium, presents with IMB, PMB, menorrhagia, irregular bleeding

A

endometrial hyperplasia

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93
Q

fibroids symptoms

A

asymptomatic, menorrhagia, infertility, abdo mass, pain (if torsion), dysuria, hydronephrosis, constipation, sciatica, bloating, dysmenorrhoea, urinary retention

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94
Q

asymptomatic, menorrhagia, infertility, abdo mass, pain, dysuria, hydronephrosis, constipation, sciatica, bloating symptoms of

A

fibroids

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95
Q

fibroids management

A

IUS, tranexamic acid, COCP, NSAIDs, progesteroenes, Sx (myomectomy, hysteroscopic endometrial ablation, hysterectomy)

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96
Q

fibroids associations

A

most common near the menopause, rare before puberty + after menopause, more common in Afro-Carribeans, FH

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97
Q

most common near the menopause, rare before puberty + after menopause, more common in Afro-Carribeans, FH

A

fibroids

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98
Q

fibroids investigations

A

TVUS, MRI, laparoscopy (differentiate from an ovarian mass/adenomyosis)

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99
Q

benign conditions that can raise CA125

A

endometriosis, menstruation, benign ovarian cysts

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100
Q

premature ovarian failure

A

menopausal symptoms <40 y.o.

symptoms: hot flushes, night sweats, infertility, 2’ amenorrhoea, raised FSH, raised, LH

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101
Q

hot flushes, night sweats, infertility, 2’ amenorrhoea, raised FSH, raised, LH

A

premature ovarian failure

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102
Q

premature ovarian failure causes

A

idiopathic, chemo, radiation, AI

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103
Q

premenopausal ovarian masses

A

follicular/lutein cyst, dermoid cyst, endometriomas, benign epithelial tumour

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104
Q

follicular/lutein cyst, dermoid cyst, endometriomas, benign epithelial tumour most common massees in

A

premenopausal

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105
Q

post menopausal ovarian masses

A

benign epithelial tumour, ca

106
Q

benign epithelial tumour, ca most common masses in

A

postmenopausal

107
Q

types of cyst

A

physiological/functional cysts, benign germ cell tumours, benign epithelial tumours

108
Q

physiological/functional cyst comprise

A

follicular cysts + corpus luteum cysts

109
Q

follicular cyst

A

commonest, due to non-rupture of the dominant follicle/failure of atresia in non-dominant follicle, regress after several menses

110
Q

corpus luteum cyst

A

instead of corpus luteum breaking down if no pregnancy it fills with blood/fluid, intraperitoneal bleeding

111
Q

benign germ cell tumours comprise

A

dermoid cysts aka mature cystic teratomas

112
Q

dermoid cysts

A

lines with epithelial tissue (therefore may contain skin, hair, teeth), > common benign ovarian tumour in >30 y.o., asymptomatic, torsion risk

113
Q

benign epithelial tumours comprise

A

serous cystadenoma + mucinous cystadenoma

114
Q

serous cystadenoma

A

bears resemblance to serus carcinoma (most common type of ovarian ca)

115
Q

mucinous cystadenoma

A

large, may become massive, rupture may cause pseudomyxoma peritonei

116
Q

pseudomyxoma peritonei

A

cancerous cells producing abundant mucin or gelatinous ascites

117
Q

follicular cysts + corpus luteum cysts are

A

physiological/functional cysts

118
Q

commonest, due to non-rupture of the dominant follicle/failure of atresia in non-dominant follicle, regress after several menses

A

follicular cyst

119
Q

instead of corpus luteum breaking down if no pregnancy it fills with blood/fluid, intraperitoneal bleeding

A

corpus luteum cyst

120
Q

dermoid cysts aka mature cystic teratomas are

A

benign germ cell tumours

121
Q

lines with epithelial tissue (therefore may contain skin, hair, teeth), > common benign ovarian tumour in >30 y.o., asymptomatic, torsion risk

A

dermoid cyst

122
Q

serous cystadenoma + mucinous cystadenoma are

A

benign epithelial tumours

123
Q

bears resemblance to serus carcinoma (most common type of ovarian ca)

A

serous cystadenoma

124
Q

large, may become massive, rupture may cause pseudomyxoma peritonei

A

mucinous cystadenoma

125
Q

cancerous cells producing abundant mucin or gelatinous ascites

A

pseudomyxoma peritonei

126
Q

cysts in early pregnancy

A

usually physiological, resolve from 2nd trimester, reassurance

127
Q

whirl pool sign on US

A

ovarian torsion or bowel volvulus

128
Q

endometrial ca is most commonly what type of ca

A

adenocarcinoma

129
Q

endometrial ca risk factors are “broadly speaking” due to

A

high oestrogen:progesterone ratio

endometrial ca develops when there’s high oestrogen/when oestrogen therapy = unopposed by progesterone

130
Q

how does obesity increase risk of endometrial ca

A

peripheral conversion of androgens to oestrogens

131
Q

peripheral conversion of androgens to oestrogens is the mechanism whereby

A

obesity contributes to endometrial ca risk

132
Q

how does PCOS increase risk of endometrial ca

A

prolonged periods of amenorrhoea

133
Q

prolonged periods of amenorrhoea is the mechanism whereby

A

PCOS contributes to endometrial ca risk

134
Q

protective factors for endometrial ca

A

COCP, pregancy

135
Q

endometrial ca presentation

A

PMB, in premenopausal women: oligomenorrhagia, IMB, recent onset menorrhagia, abnormal smear

136
Q

stage 1 endometrial ca

A

confined to uterus

137
Q

stage 2 endometrial ca

A

uterus + cervix

138
Q

stage 3 endometrial ca

A

invaded through uterus

139
Q

stage 4 endometrial ca

A

distant spread

140
Q

Nexplanon/Implanon

A

forms of implant

141
Q

forms of implant

A

Nexplanon/Implanon

142
Q

implant mechanism of action

A

slow release progesterone, prevents ovulation, thickens cervical mucus

143
Q

pros of the implant

A

highly effective, long lasting (3 yrs), no oestrogen (no VTE, migraine risk)

144
Q

cons of the implant

A

professional needs to insert/remove, 7/7 until it’s effective, irregular/heavy periods, headache, N, breast pain

145
Q

long term complications of PCOS

A

subfertility, DM, stroke, TIA, CAD, OSA, endometrial ca

146
Q

subfertility, DM, stroke, TIA, CAD, OSA, endometrial ca are long term complications of

147
Q

features of PCOS

A

subfertility/infertility, oligomenorrhoea/amenorrhoea, hirsuitism, acne, obesity, acanthosis nigricans

148
Q

PCOS investigations

A

US, FSH, LH, prolactin, TSH, testosterone, OGTT

149
Q

PCOS results

A

raised LH:FSH, prolactin N/mildly raised, testosterone N/mildly raised

150
Q

cervical ectropion symptoms

A

PCB, vaginal discharge

151
Q

cervical ectropion causes

A

elevated oestrogen: COCP, ovulatory phase, pregnancy

152
Q

cervical ectropion management

A

ablation for troublesome symptoms

153
Q

fibroids aka

A

leiomyomata

154
Q

leiomyomata aka

155
Q

fibroids are

A

benign tumours of the myometrium

156
Q

benign tumours of the myometrium

157
Q

fibroids are rare in

A

parous women, COCP use, injectable progestogens

158
Q

parous women, COCP use, injectable progestogens rarely get

159
Q

types of fibroid

A

intramural, subserosal (+ subserosal polyps), submucosal (occasionally for intracavity), cervical

160
Q

growth of fibroids is probably dependent on

A

oestrogen + probably progesterone

161
Q

fibroid complicaitons

A

torsion of pedunculated fibroid, red degeneration, enlargement in mid-pregnancy, calcification(postmenopausal + asymptomatic), leiomyosarcoma

162
Q

red degeneration of a fibroid

A

normally due to inadequate blood supply, pain, uterine tenderness, haemorrhage, necrosis

163
Q

pregnancy complications of fibroids

A

premature labour, malpresentation, transverse lie, obstructed labour, PPH, red degeneration, postpartum torsion of pedunculated fibroids

164
Q

myomectomy + fertility

A

will preserve fertility, may require c/s at delivery (risk of uterine rupture), risk of adhesions

165
Q

medication used to reduce size of fibroid whilst awaiting Sx

A

GNRH analogue

166
Q

medical Rx for fibroids parameters (i.e. IUS, transaxamic acid, COCP)

A

fibroid <3cm, not distorting the uterine cavity

167
Q

fibroid <3cm, not distorting the uterine cavity is the criteria for

A

medical fibroid management e.g. IUS, transaxamic acid, COCP

168
Q

degeneration of fibroid during pregnancy presentation

A

low grade fever, pain, V

169
Q

degeneration of fibroid during pregnancy management

A

rest, analgesia

170
Q

endocervix is lined by

A

columnar, glandular epithelium

171
Q

ectocervix is lined with

A

squamous epithelium

172
Q

CIN is the

A

presence of atypical cells w/i the squamous epithelium, dyskaryotic cells with enlarged nuclei + f mitoses

173
Q

CIN I

A

mild dysplasia, abnormal cells found in the lower 1/3 of epithelium

174
Q

CIN II

A

moderate dysplasia, cells found in lower 2/3 of epithelium

175
Q

CIN III

A

severe dysplasia, atypical cells found throughout the epithelium

176
Q

CIN III aka

A

carcinoma in situ

177
Q

cervical ca risk factors

A

HPV infection, promiscuity, early first intercourse, smoking, COCP, immunocompromise

178
Q

cervical ca screening programme

A

25-49 3 yearly, 50-64 5 yearly, >65 for those not screened since 50/abnormal smears

179
Q

dysplasia vs dyskaryosis

A

dyskaryosis = smear test result, loosely linked to severity of CIN, dysplasia = from biopsy

180
Q

mild/borderline smear result

A

HPV test, if +ve to colposcopy, if -ve return to routine screening

181
Q

HPV test, if +ve to colposcopy, if -ve return to routine screening

A

mild/boarderline smear result

182
Q

moderate smear

A

colposcopy

183
Q

severe smear

A

urgent colposcopy

184
Q

colposcopy for

A

moderate smear/HPV +ve in mild/borderline

185
Q

urgent colposcopy

A

severe smear

186
Q

CIN I/II management

A

LLETZ/diathermy loop excision

187
Q

LLETZ complications

A

bleeding, infection, preterm delivery

188
Q

stage 1 cervical carcinoma

A

confined to cervix

189
Q

stage 2 cervical carcinoma

A

invasion to vagina

190
Q

stage 3 cervical carcinoma

A

invasion to lower vagina, pelvic wall, ureteric obstruciton

191
Q

stage 4 cervical carcinoma

A

further spread

192
Q

stage 1 cervical carcinoma management

A

cone biopsy/simple hysterectomy

193
Q

stage 2 cervical cancer management

A

laparoscopic LN resection, radical trachelectomy, removal of cervix (+/- uterus) + upper part of vagina, chemo-radiotherapy

194
Q

stage 3 + 4 cervical carcinoma management

A

chemoradiotherapy

195
Q

COCP pros

A

effective (99%), doesn’t interfere with sex, reversible, periods regular, lighter, less painful, relieves PMT, reduces ovarian, endometrial + CRC risk, ?protective against PID, ?reduces ovarian cysts, benign breast DZ, acne vulgaris

196
Q

COCP cons

A

forget to take it, no STI protection, increased VTE risk, increased breast + cervical ca risk, increased stroke + IHD risk, SE: headache, N, breast tenderness, tiredness, change in libido, breakthrough bleeding, skin changes, mood changes, rise in BP

197
Q

VIN

A

vulval intraepithelial neoplasm, presence of atypical cells in the vulval epithelium. Usual type vs differentiate type

198
Q

usual type VIN presentation

A

35-55 y.o. females, multifocal, red/white/pigmented, plaques/patches/papules, erosions/nodules/warty/hyperkeratotic, pruitis, pain

199
Q

usual type VIN associated with

A

HPV, CIN, cigarette smoking, chronic immunosuppression, SCC

200
Q

differentiated type VIN presentation

A

rarer, older women, unifocal, ulcer/plaque, pruitis, pain

201
Q

differentiated type VIN is associated with

A

lichen sclerosis, linked to keratising SCC, high risk of progression to ca

202
Q

VIN management

A

Sx excision, topical emollients/steroids for symptom relief

203
Q

carcinoma of the vulva type

A

SCC = majority, melanoma, basal cell carcinoma, adenocarcinoma, sarcoma

204
Q

vulval ca associations

A

lichen sclerosis, immunosuppression, smoking, Paget’s DZ of the vulva

205
Q

vulva ca Hx

A

pruitis, bleeding, discharge, mass

206
Q

vulval ca O/E

A

ulcer/mass on labia majora/clitoris, inguinal lymphadenopathy

207
Q

stage 1 vulva ca

A

confined to vulval perineum

208
Q

stage 2 vulva ca

A

spread to urethra/vagina/anus

209
Q

stage 3 vulva ca

210
Q

stage 4 vulva ca

A

further invasion/mets

211
Q

vulval ca investigations

A

biopsy, Sx assessment: CXR, ECG, FBC, U+E, x-match

212
Q

management of vulval ca

A

stage 1 DZ = resection, >stage 1 = wide local excision, groin lymphadenectomy

213
Q

complications of vulva ca Sx

A

would breakdown, infection, leg lymphoedema, lymphocyst formation, sexual/body image problems

214
Q

35-55 y.o. females, multifocal, red/white/pigmented, plaques/patches/papules, erosions/nodules/warty/hyperkeratotic, pruitis, pain

A

usual type VIN presentation

215
Q

differentiated VIN presentation

A

rarer, older women, unifocal, ulcer/plaque, pruitis, pain

216
Q

lichen sclerosis, immunosuppression, smoking, Paget’s DZ of the vulva are associated with

217
Q

would breakdown, infection, leg lymphoedema, lymphocyst formation, sexual/body image problems are complications of

A

vulval ca Sx

218
Q

median age of menopause

219
Q

perimenopause

A

vasomotor symptoms, menstrual irregularity

220
Q

surgical menopause

A

after bx removal of ovaries

221
Q

causes of premature menopause

A

infection, AI DZ, chemo, ovarian dysgenesis, metabolic DZ

222
Q

management of premature menopause

A

HRT is recommended until 50 y.o.

223
Q

systemic consequences of monopause

A

CVS DZ, stroke, vasomotor symptoms, urogenital problems, sexual problems, osteoporosis

224
Q

vasomotor symptoms associated with the menopause

A

hot flushes, night sweats (leading to sleep disturbances, tiredness, irritability), present for < 5yrs

225
Q

urogenital problems caused by the menopause

A

oestrogen deficiency causes vaginal atrophy (dyspareunia, cessationof sexual activity, reduced libido, pruitis, burning, dryness), uringary symptons: f, urgency, nocturia, incontinence, recurrent infection

226
Q

osteoporosis definitions

A 
N = T score -/- -1 and +1
osteopenia = T score -/- -2.5 and -1
osteoporosis = T score < -2.5
227
Q

most common sites for osteoporotic #

A

wrist/Colles’ #, hip, spine

228
Q

risk factors for developing osteoporotic #

A

parental Hx of hip #, early menopause, chronic corticosteroid use, prolonges immobilisation, prior #, low BMI, cigarette smoking, EtOH abuse, low Ca intake, sedentary lifestyle, RA, NMD, chronic liver DZ, malabsorptionS, hyperparathyroidism, hyperthyroidism, hypogonadism

229
Q

menopause investigations

A

FSH, anti-Mullerian hormone, TFT, catecholamines, LH, oestradiol, progesterone, bone density

230
Q

FSH in menopause

A

gives an indicaion of ovarian reserve, increased = fewer oocytes, used in premature menopause

231
Q

when should FSH be measured

A

between days 2-5 of cycle, in amenorrhoeic do 2 samples 2/52 apart

232
Q

anti-Mullarian hormone

A

gives direct measurement of ovarian reserve, low = ovarian failure

233
Q

when should anti-Mullarian hormone be measured

234
Q

menopause management

A

HRT (oestrogen alone in women w/o uterus, combined in others)

235
Q

methods of administration of HRT

A

PO, transdermally, s/c (implant - oestrogens), topical (vaginally - oestrogens), IUS (progestogens)

236
Q

pros of HRT

A

Rx for hot flushes, vaginal dryness, soreness, superficial dyspareunia, urinary f, urgency, reductionin risk of osteoporosis, reduced risk of CRC, reduced risk of CVS DZ, protection against ovarian ca

237
Q

cons of HRT

A

breast ca (combined), endometrial ca (oetrogen only), VTE (PO HRT), gall bladder DZ (PO HRT)

238
Q

duration of HRT

A

5 years, reassess

239
Q

alternatives to HRT for menopausal symptoms

A

hot flushes/night sweats: progestogens, clonidine, SSRI, SNRI, gabapentin
vaginal atrophy: lubricants, moisturisers
osteoporosis: bisphosphonates, strontium ranelate, raloxifene, PTH peptides, denosumab, Ca, vit D

240
Q

after bx removal of ovaries

A

surgical menopause

241
Q

infection, AI DZ, chemo, ovarian dysgenesis, metabolic DZ could be causes of

A

premature menopause

242
Q

CVS DZ, stroke, vasomotor symptoms, urogenital problems, sexual problems, osteoporosis are all complications of

A

the menopause

243
Q

gives an indicaion of ovarian reserve, increased = fewer oocytes, used in premature menopause

244
Q

take sample between days 2-5 of cycle, in amenorrhoeic do 2 samples 2/52 apart

245
Q

gives direct measurement of ovarian reserve, low = ovarian failure

A

anti-Mullarian hormone

246
Q

contraception in perimenopausal women is recommended for

A

12/12 after last period, 24/12 in menopausal women <50 y.o.

247
Q

COCP CI

A

person Hx/FH VTE, currently pregnant, unexplained vaginal bleeding, severe liver DZ, HbSS, smoking, migraine

248
Q

endometriosis causes

A

inflammation which leads to fibrosis and adhesions to form w/i the uterus, chocolate cysts

249
Q

chocolate cysts

A

named so becuase accumulated altered blood is dark brown

250
Q

endometriosis Hx

A

cyclical chronic pelvic pain, menstrual irregularity, dysmenorrhoea, subfertility, deep dyspareunia, asymptomatic, pain on defaecating during menses, rupture of chocolate cyst leads to acute pain, cyclical bowel/bladder symptoms

251
Q

endometriosis O/E

A

VE: tenderness, thickening behind uterus/in adenexa, retroverted innomile uterus (in advnced cases), may be N

252
Q

endometriosis investigations

A

laparoscopy +/- biopsy, active lesions = red vesicles/punctate marks, less active lesions = white scars/brown spots
TVUS, MRI

253
Q

endometriosis DD

A

adenomyosis, chronic PID, chronic pelvic pain, pelvic mass, IBS

254
Q

endometriosis Mx

A

NSAIDs, paracetamol, opiates, IUS, COCP, POP, GNRH analogues, laparascopic diathermy/laser, dissection, hysterectomy + BSO

255
Q

POP SE

A

fluid retention, weight gain, erratic bleeding, PMS-like symptoms

256
Q

GNRH analogues SE

A

menopausal symtoms, reversible bone demineralisation, (limits therapy to 6/12)

257
Q

endometritis

A

infection of the endometrium

258
Q

endometritis causes

A

2’ to STI, complication of Sx (c/s, intrauterine termination), IUD, retained products of conception, malignancy (post-menopausal)

259
Q

endometritis presentation

A

persistent, heavy bleeding, pain, tender uterus

260
Q

HRT CI

A

breast ca, PV bleeding, breastfeeding, DVT/PE

Medicine (30 decks)

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