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GOSH > Gynae > Flashcards

Gynae Flashcards

1
Q

what is the average age of menarche?

A

12 years (8-16)

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2
Q

what is mittelzchmerz?

A

peri-ovulatory, unilateral pelvic pain

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3
Q

what causes ovulation?

A

LH surge

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4
Q

is oestrogen higher in the proliferative or luteal phase?

A

proliferative/ follicular

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5
Q

which phase of the menstrual phase is progesterone highest in?

A

luteal phase as is released by corpus luteum

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6
Q

how long does the corpus luteum survive?

A

14 days

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7
Q

what does the hypothalamus release?

A

gonadotropin releasing hormone

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8
Q

what does the anterior pituitary release?

A

FSH and LH

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9
Q

feedback mechanisms in the menstrual cycle

A

FSH stimulates release of oestrogen
oestrogen provides -ve feedback so decreases FSH and +ve feedback to increase LH
LH stimulates release of progesterone
progesterone has -ve feedback on pituitary so decreases LH

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10
Q

causes of abnormal bleed mnemonic

A 
PALM (strutctural) COEIN
Polyp/ pregnancy
Adenomyosis
Leiomyoma
Malignancy endometrial/ cervical
Coagulopathy
Ovulation (disorders of)- PCOS, hypothyroid
Endometrial- fibroids/ endometriosis
Iatrogenic (POP/IUCD etc)
Not yet classified
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11
Q

what is PCOS?

A

unexplained chronic hyperandronergic anovulation

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12
Q

what are signs of PCOS?

A

hirstutism
male pattern balding
acne
insulin resistance (obesity, cenrtal fat distribution, acanthosis nigricans)

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13
Q

what criteria can be used to assess PCOS?

A

Rotterdam criteria; 2/3 of:
polycystic ovaries on USS
oligo/ anovulation
signs of excess androgens

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14
Q

how is the pituitary axis affected in PCOS?

A

increased oestrogen from peripheral adipose-> stimulates more LH from anterior pituitary-> androgen production-> converted to oestrogens peripherally…

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15
Q

what are the long term risks of PCOS?

A

infertility
CVD
DM2
endometrial carcinoma

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16
Q

what is the treatment of PCOS?

A

contraception

if trying to conceive- metformin, clomiphene citrate

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17
Q

what is the average age of menopause?

A

51, premature <40

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18
Q

what happens to the hormones during menopause?

A

oestrogen and progesterone decrease

therefore LH/ FSH increase

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19
Q

what is the perimenopausal period known as

A

climacteric

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20
Q

what symptoms suggest a woman is perimenopausal?

A 
weight gain (especially abdo/ buttocks)
menstrual irregularity 
vasomotor- night sweats, hot flushes, palpitations
mood swings
vaginal atrophy
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21
Q

what are post-menopausal women at increased risk of?

A

osteoporosis

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22
Q

what is menopause?

A

amenorrhoea for at least 12 months

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23
Q

how are menopausal women treated?

A

HRT- sequential if menstruating, continuous combined if not. unopposed oestrogen if had hysterectomy
bisphosphonates if indicated by DEXA

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24
Q

what are the side effects of HRT?

A 
Increased risk of VTE
increased risk of breast/ cervical cancer
CVD risk
Breast tenderness
PV bleed
headaches
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25
Q

when could oestrogen only therapy be a possibility?

A

if the woman has had a hysterectomy

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26
Q

what are the most common features of endometriosis?

A

infertility
deep dyspareunia
secondary dysmenorrhoea
pelvic pain- typically starts 2 weeks pre-bleed and bleed helps relieve it

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27
Q

what are risk factors for endometriosis?

A

early menarche/ late menopause
no kids
family history

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28
Q

what is the gold standard for diagnosis of endmetriosis?

A

laparoscopy

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29
Q

what can be used for effective pain relief in endometriosis?

A

mefanamic acid (NSAID)

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30
Q

what treatments can be used to stop complications of endometriosis?

A 
tricycling COCP (take 3 packets back to back)
progestagens
anti-progestagins
laparoscopic ablation/ excision
hysterectomy
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31
Q

what are risk factors for an ectopic pregnancy?

A 
PID
tubal surgery eg previous ectopic/ pelvic surgery
IUCD
IVF
if conceives on POP
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32
Q

what are common locations for an ectopic?

A

tubal- ampulla/ isthmus/ cornual)
cervical
ovarian

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33
Q

other than abdominal pain/ PV bleed, what would make you suspicious of an ectopic?

A

shoulder tip pain

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34
Q

how would the results of 2 BhCG tests help you distinguish between an ectopic and an IUP?

A

take 2 samples 48 hours apart
if doubles = IUP
if decreases = miscarriage
if stays the same/ increases but not doubled = ectopic

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35
Q

when is the medical treatment of an ectopic appropriate?

A 
if BhCG <1500u/L
no significant pain
mass <35mm
no foetal heart beat
no IUP
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36
Q

what is the medical treatment for an ectopic?

A

methotrexate IM, advise may require surgical treatment also

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37
Q

how often should you check BhCG after medical treatment of an ectopic?

A

day 4 and 7, then weekly until negative. may take 4-6 weeks to resolve

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38
Q

what is the surgical management of an ectopic?

A

salpingectomy/ salpingotomy if damage to other tube. give anti-D prophylaxis
repeat PT after 3 weeks

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39
Q

criteria for PID

A

Lower abdo pain +
1 of; pyrexia >38/ ESR>15/ Luecocytosis+
1 of; adnexal pain/ adnexal mass/ CMT

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40
Q

what pain is common in PID?

A

deep dyspareunia

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41
Q

treatment for PID?

A

IM ceftriaxone 500mg then PO doxycycline and metronidazole for 14 days

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42
Q

after how many consecutive miscarriages would you start investigations?

A

3

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43
Q

investigations for abnormal bleeding?

A

bloods- FBC, TFT, coag screen
USS
may require hysteroscopy and biopsy

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44
Q

treatment for abnormal bleeds?

A

Medical- COCP, mefenamic/ tranexamic acid, mirena coil for fibroids,
surgical depending on cause

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45
Q

STI tests for women with symptoms?

A

vvs for chlamydia and gonorrhoea NAAT
HVS for TV, BV, candida
endocervical swab for gonorrhoea culture
bloods for HIV and syphilis

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46
Q

STI tests for asymptomatic women?

A

vvs for chlamydia and gonorrhoea NAAT

bloods for HIV and syphilis

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47
Q

STI tests for men with symptoms?

A

1st pass urine for chlamydia and gonorrhoea NAAT
urethral swab for gonorrhoea culture
blood for HIV and syphilis
if MSM: also do rectal + pharyngeal swab for NAAT and culture and offer hep B vaccine

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48
Q

STI tests for men without symptoms?

A

1st pass urine for chlamydia and gonorrhoea NAAT

blood for HIV and syphilis

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49
Q

vaginal discharge with contact bleed and “cobblestone cervix” on speculum

A

chlamydia, treat with azithromyicin 1g single dose

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50
Q

green/ yellow PV discharge, IMB, dysuria

A

gonorrhoea

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51
Q

pH suggestive of BV

A

> 4.5

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52
Q

Treatment for BV

A

PO metronidazole

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53
Q

white cheesy discharge

A

candida, treat with topical clotrimazole/ pessary

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54
Q

treatment for gonorrhoea

A

once only:
IM cefetriaxone 500mg
PO azithromycin 1g

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55
Q

gonorrhoea in pregnancy concerns?

A

causes blindness in foetus

56
Q

what causes chlamydia

A

chlamydia trichomatis

57
Q

complications of chlamydia in pregnancy?

A

PROM/ pre-term delivery
low foetal birth weight
neonatal ophthalmic infection
neonatal pneumonitis

58
Q

what organism causes gonorrhoea?

A

Neisseria gonorrhoeae

59
Q

which organism causes syphilis?

A

Treponema pallidum

60
Q

how is syphilis spread?

A

skin abrasions/ intact mucous membranes

61
Q

how long is the incubation period of syphilis?

A

3 weeks until primary local infection, 6-12 weeks for generalised secondary infection

62
Q

how does primary syphilis present?

A

chancre- small painless papule which ulcerates and may discharge clear fluid, heals in 2-6 weeks

63
Q

how does secondary syphilis present?

A

6 weeks after chancre
systemic symptoms (malaise/ fever etc)
generalised polymorphic rash on palms/ soles/ face
lymphadenopathy

64
Q

what percentage of untreated primary syphilie develops into secondary?

A

25%

65
Q

what percentage of untreated secondary syphilis develops into latent asymptomatic syphilis?

A

80%

66
Q

what are the neuro manifestations of tertiary syphilis

A

tabes dorsalis- 15 to 25 years after primary infection, locomotor ataxia
dementia

67
Q

what are the cardiovascular manifestations of tertiary syphilis?

A

aortitis-> aortic regurgitation, aneurysm

68
Q

what are gumma?

A

tertiary syphilis-> soft locally-destructive non-cancerous growths

69
Q

what is the treatment for syphilis?

A

benzathine penecillin

70
Q

what are non-infective differentials for PV discharge?

A

physiological
pregnancy
retained FB
chemical irritants

71
Q

what causes trichomonas?

A

protozoan infection

72
Q

what colour is the discharge in trichomonas?

A

yellow and frothy

73
Q

treatment for trichomonas?

A

one off metronidazole

74
Q

what is balanitis?

A

infection of the glans penis

75
Q

causes of balanitis?

A 
intertrigo (rubbing)
candida
bacterial: staph/ group B strep
viral
lichen planus/ lichen sclerosis
contact allergy
eczema/ psoriasis
76
Q

how would candidial balanitis present?

A

red papules + superficial erosions and white plaques

77
Q

what condition should you consider checking for if someone presents with candidial balanitis?

A

DM

78
Q

how would balanitis due to lichen sclerosis present?

A

pale atrophic skin, telangectasia

79
Q

why should balanitis due to lichen sclerosis have biopsy + long-term follow up?

A

risk of malignancy

80
Q

treatment for scabies balanitis?

A

topical permethrin

81
Q

treament for balanitis due to lichen sclerosis?

A

topical steroids

82
Q

treatment for candidal balanitis?

A

canestan

83
Q

treatment for eczema/ psoriasis balanitis?

A

topical betnovate

84
Q

which type of HSV causes genital lesions

A

mostly 2 but now 1 as well (increase in oral sex)

85
Q

how would HSV infection present?

A

painful shallow ulcer

86
Q

what is the incubation period of HSV?

A

2 days- 2 weeks

87
Q

treatment of recurrence of HSV?

A

acyclovir, avoid sex, analgesia

88
Q

frequency of recurrence of HSV?

A

Median 4/ year

89
Q

what causes genital warts?

A

HPV 6 and 11

90
Q

which types of HPV are associated with and increased risk of cancer?

A

HPV 16/ 18

91
Q

which types of cancer are increased in people infected with HPV 16/ 18?

A

cervical, vaginal, penile, anal and oral

92
Q

what are the treatment options for genital warts?

A

often self resolve in 6 months (may recur)

medical: podophyllotoxin/ imiquimod 5%
surgical: ablation/ cryotherapy/ excision

93
Q

what ages are prone to testicular torsion?

A

neonates and post-puberty

94
Q

which testes is more prone to torsion?

A

left

95
Q

what deformity increases the risk of testicular torsion?

A

Bell-Clapper

96
Q

would lifting the tests increase or decrease the pain in torsion?

A

increase, decreases in epididymitis

97
Q

what is the cremasteric reflex and when would it be absent?

A

stroking of inner thigh causes raising of testes, absent in torsion

98
Q

what age to testes descend?

A

34 weeks in utero

99
Q

at what age are testes checked in neonates?

A

just born, 6 weeks and 18 months

100
Q

when would you operate on an undescended testicle

A

1-2 years orchidopexy as can still descend until then

101
Q

what organisms are most common causative organisms of prostatitis?

A

gram negative

then STI

102
Q

How is prostatitis diagnosed?

A

urine culture

103
Q

what is the treatment for prostatitis

A

fluoroquinolones eg ciprofloxacin

104
Q

at what age does a physiological phymosis start to resolve

A

2, 95% resolved by 16 years

105
Q

what would indicate a pathalogical phymosis

A

haematuria, urinary obstruction, painful erection. recurrent UTIs can occur in physiological phymosis

106
Q

what are medical treatments for phymosis?

A

topical steroids onto preputial ring

107
Q

what is phymosis a risk factor for?

A

penile cancer

108
Q

what are surgical options for treating phymosis?

A

dorsal incision/ circumcisison

109
Q

what is paraphymosis?

A

retracted prepuce causes swelling and inability to replace, emergency

110
Q

what may aid the replacement of a paraphymosis?

A

compression with saline soaked swab/ 50% dextrose
ice
ask patient to squeeze glans for up to 30 minutes

111
Q

what are some causes of erectile dysfunction?

A

Vascular: CVD, trauma, surgery
Neuro: central/ peripheral
Hormonal: hypogonadism, exogenous anabolic steroids
Anatomical
Drugs: psych drugs, BB, anti-HTN, prostate cancer tx
psychogenic: general/ situational

112
Q

what else should be investigated in someone presenting with erectile dysfunction?

A

CVD risk factors

113
Q

what class of drug is viagra

A

phosphodiesterase type 5 inhibitor

114
Q

what is viagra’s drug name

A

sildenafil

115
Q

when is viagra contraindicated?

A

if on nitrates as increased risk of stroke/ MI

116
Q

what is the most common cause of epididymo-orchitis in under 35s?

A

STI

117
Q

what is the most common cause of epididymo-orchitis in over 35s?

A

UTIs

118
Q

scrotal pain and swelling which is improved by elevation?

A

epididymo-orchitis

119
Q

what are the classifications of urethritis?

A

gonococcal/ non-gonococcal/ persistent/ recurrent

120
Q

what is the most common cause of urethritis?

A

non-gonococcal e.g. chlamydia

121
Q

what causes an increase in alpha feto-protein

A

yolk sac tumours

122
Q

what is the most common form of testicular tumour?

A

seminoma

123
Q

what causes an increase in BhCG?

A

seminoma/ teratoma

124
Q

if carrying out an orchidectomy for testicular cancer what should you consider before?

A

sperm collection and storage

125
Q

who should be offered genetic testing for breast cancer?

A

manchester scoring system
men
young women with triple negative
women with other cancers, e.g. ovarian

126
Q

where is breast cancer most commonly found?

A

left breast, outer upper quadrant

127
Q

what type of breast cancer is most common?

A

ductal carcinoma

128
Q

are most breast cancers oestrogen receptor + or -

A

+ve, better prognosis

129
Q

what is the HER2 receptor

A

growth factor receptor, if positive worse prognosis but can be treated with herceptin (trastuzamab)

130
Q

when would neoadjuvant chemo be useful for breast cancer?

A

for breast conservation or if HER2 positive/ triple negative as better response

131
Q

why would adjuvant chemotherapy be used in breast cancer?

A

for micrometastatic disease

132
Q

how is a fibroadenoma differentiated from a cancer?

A

mobile, younger woman (peak early 20s)

133
Q

what age is the cut off for 2 week wait referral for a breast lump?

A

30 (over 30 2ww, under 30 non-urgent)

134
Q

what factors increase the risk of a breast abscess?

A

breast feeding
immunocompromise/ DM
nipple piercing

135
Q

what should be excluded in mastitis or breast abscess

A

inflammatory breast cancer

136
Q

how should a breast abscess be treated?

A

incision and drainage, send swab for culture, Abx eg fluclox?

GOSH (2 decks)

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