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gynae Flashcards

1
Q

how to gnrh analogues work?

A

pulsatile buserelin, goserelin stimulates AP to secrete LH + FSH

continuous downregulates AP → decreased LH + FSH release → decreased oest + progest → amenorrhoea; fibroids shrink

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2
Q

what are effects of oestrogen?

A 
bone + muscle growth
endometrial growth
maintains female 2° characteristics
maintains breasts
low conc - inhibits LH
high conc - stimulates LH
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3
Q

oligo/amenorrhoea - investigations

A

pregnancy test

FSH + LH:
low - HT/AP pathology
normal - oocytes present but problem with folliculogenesis eg PCOS
high - concerning - few oocytes - eg POF

AMH:
best predictor of oocyte reserve

oestradiol: ovarian function
prolactin: ?pituitary problem
testosterone: ?PCOS

USS

TFTs

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4
Q

hypothalamic ovulatory dysfunction - findings

A

FSH + LH low
oestradiol low
GnRH deficiency
weight loss

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5
Q

pituitary ovulatory dysfunction - findings

A

FSH + LH low
oestradiol low
hyperprolactinaemia

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6
Q

ovarian ovulatory dysfunction - PCOS findings (bloods)

A

FSH + oestradiol normal

LH high - problem with final stage of folliculogenesis

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7
Q

ovarian ovulatory dysfunction - premature ovarian failure findings (bloods)

A

FSH + LH high

oestradiol low

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8
Q

how can you test for ovulation + ovarian reserve?

A

regular cycle confirms ovulation - if not do serum progesterone 7d after ovulation

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9
Q

male infertility - investigations

A

semen analysis x 2 - abstain 2-5d

if 1st sample abnormal, reassess after 3mo

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10
Q

female infertility - advice

A

smoking + drugs
BMI 20-25
sex every 2-3 days
folic acid + vit D - NTDs

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11
Q

female subfertility - investigations

A

bloods - FSH, LH, oestrogen, prolactin, AMH
transvaginal USS
imaging for patency of fallopian tubes

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12
Q

PCOS - investigations

A 
pelvic USS - ovaries > 10mm, cysts++
LH - raised (↑LH:FSH)
FSH - low 
prolactin - poss slight↑
testosterone - poss slight↑
glucose tolerance
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13
Q

PCOS - symptoms

A

irregular/amenorrhoea
hirsutism
acne
obesity

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14
Q

PCOS - diagnostic criteria

A

2 of:
irregular menses
androgen excess on bloods/examination - hirsutism, acne (not obesity)
PCO - >10cm3

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15
Q

PCOS - mgmt

A

COCP
weight loss
fertility - clomiphene +- metformin

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16
Q

how does clomiphene work?

A

helps induce ovulation

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17
Q

endometriosis - symptoms

A

dysmenorrhoea + dyspareinuria - main 2
dysmenorrhoea often starts days before bleeding
dyschesia + haematochaesia, urinary symptoms

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18
Q

how does endometriosis cause infertility?

A

endometrial lesions cause inflammatory reaction - scarring + adhesions - distorted pelvic anatomy

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19
Q

endometriosis - management

A

1st line - NSAIDs +- paracetamol +- COCP (pregnancy-like state of endometrium) or progestogen eg the injection

2° - refer to gynae:
GnRH analogue - short term (fake menopause - night sweats + hot flushes; osteoporosis risk)

3° - lap excision/laser/cauterisation of lesions; lysis of adhesions; H + BSO

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20
Q

subfertility in PCOS - mgmt

A

1st line - weight loss

2nd - clomiphene - induce ovulation. then USS to check follicle development + reduce multiple pregnancies

21
Q

subfertility due to tubal problems - causes + management

A

infection, adhesions from surgery, endometriosis

IVF

22
Q

subfertility due to sperm problems - mgmt

A

lifestyle

IVF + ICSI (intracytoplasmic sperm injection)

23
Q

what is a complication of IVF? how does it present, findings + mgmt?

A

ovarian hyperstimulation syndrome

severe lower abdo pain
vomiting
distended + tender abdo

USS - enlarged, cystic ovaries, ascites, pleural effusion

oral fluids
thromboprophylaxis
paracentesis

24
Q

definition of secondary amenorrhoea

A

menstruation stopped for at least 6mo

25
Q

secondary amenorrhoea - causes

A 
hypothalamic - stress, exercise
PCOS
hyperprolactinaemia
premature ovarian failure
thyrotoxicosis
26
Q

primary dysmenorrhoea - management

A

1st line - NSAIDs (mefenamic acid, ibuprofen) - inhibit PG production
2nd line - COCP

27
Q

secondary dysmenorrhoea - when does it occur? causes? what should the GP do?

A

usually develops years after menarche
starts 3-4d before period onset

endometriosis / adenomyosis
PID
IUD
fibroids

refer to gynae

28
Q

endometriosis - investigation

A

laparoscopy
refer to gynae if symptoms significant

USS may show free fluid

29
Q

young lady with abdo pain - partic investigations

A

VE
urine preg test
?abdo + pelvic USS

30
Q

ovarian torsion - presentation, diagnosis + management

A

sudden onset colicky abdo pain; vomiting; adnexal tenderness on VE
USS - free fluid
laparoscopy - diagnostic + therapeutic

31
Q

PID - presentation

A 
bilateral low abdo pain + discharge
dysuria
RUQ pain (chlamyd)
fever
deep dyspareunia
cervical excitation
32
Q

PID - investigation

A

chlamyd + gonn test
FBC - leucocytosis
preg test
high vaginal + urethral swabs

33
Q

infertility - investigations

A

semen analysis

serum progesterone 7 days before period due date

34
Q

serum progestogen interpretation (in context of infertility)

A

< 16 - repeat. if low again then refer
16-30 - repeat
>30 - indicates ovulation

35
Q

menorrhagia - causes

A 
DUB - no underlying pathology
fibroids
IUD
hypothyroid
PID
bleeding disorder eg VWD
36
Q

menorrhagia - investigations

A

FBC

transvaginal USS if symptoms suggest structural pathology - eg pressure/unusual bleeding

37
Q

menorrhagia - management

A

doesn’t need cc:
1° - mefenamic acid / tranexamic acid from day 1 of period
2° - no improvement: try other + refer

needs cc:
1° - IUS
2° - COCP
3° - long-acting progestogen eg the injection

38
Q

PID - management

A

oral ofloxacin + metronidazole
or
oral doxy + metronidazole + IM ceftriaxone

IUDs - may leave in if mild but removal may improve outcome

39
Q

PID - complications

A

infertility - 10-20%
chronic pelvic pain
ectopic

40
Q

pelvic pain - acute differentials

A 
dysmenorrhoea
mittelschmerz
ectopic - recent amenorrhoea
UTI
appendicitis
PID
ovarian torsion
miscarrriage - recent amenorrhoea
41
Q

pelvic pain - chronic differentials

A

endometriosis
IBS
ovarian cyst - unilat dull ache, intermittent +- bloating/bladder/torsion/rupture
urogenital prolapse

42
Q

what is rovsing’s sign?

A

more pain in RIF than LIF when palpating LIF

43
Q

prolapse - symptoms

A

pressure sensation

urinary symptoms incl incontinence

44
Q

post-coital bleeding - causes

A

no reason - 50%
ectropion - 33%
chlamyd, cervical ca, polyps, trauma

45
Q

vaginal candidiasis - predisposing factors

A

diabetes
abx + steroids
pregnancy
immunosuppression

46
Q

vaginal candidiasis - features

A

cottage cheese
vulvitis - dyspareunia, dysuria
itch
vulval erythema, fissuring

47
Q

vaginal candidiasis - management

A

clotrimazole pessary stat
or
oral itraconazole or fluconazole stat (CI if preg)

48
Q

recurrent vaginal candidiasis - management

A

check compliance
confirm with hi vag swab + exclude ddx eg lichen sclerosus
exclude predisposing factors

consider induction-maintenance regime

49
Q

discharge - differentials + associated symptoms

A

physiological

candida - cottage cheese, vulvitis, itch

trichomonas - offensive, yellow/green, frothy, vulvovaginitis, strawberry cervix

BV - offensive, thin, white/grey

less common - chlamyd, gonn, ectropion, foreign body, cervical ca

O&G (22 decks)

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