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Gynae Flashcards

1
Q

How long after COCP should periods return?

A

3-6 months

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2
Q

Options for emergency contraception

A

Levonorgestral (Levonelle)
Up to 72h (effectiveness reduces the longer you wait)
If vomit within 3h, take another dose
can take multiple times within 1 cycle

Ulipristal (EllaOne)
Up to 5 days (effectiveness reduces the longer you wait)
If vomit within 3h, take another dose
can NOT take multiple times within 1 cycle - condoms/ abstinence until next cycle

Copper IUD
Up to 5 days, or 5 days after ovulation
offer chlamydia testing first

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3
Q

Age for cervical screening

A

3-yearly 25-49 years
5-yearly 50-64 years
65+ if previously abnormal, or not had one since 50

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4
Q

When should a smear not be taken?

A

Menstruation
Pregnancy
Within 12 weeks of labour, TOP, miscarriage
Ongoing vaginal discharge/ pelvic infection

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5
Q

Menstruation requires which functioning 5 components

A 
Hypothalamus
Pituitary
Ovaries
Endometrium
Patent cervix/ vagina
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6
Q

What proportion of women with menorrhagia will have iron-deficiency anaemia?

A

two-thirds

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7
Q

Systemic causes of menorrhagia

A

Thyroid disease

Clotting

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8
Q

Local causes of menorrhagia

A 
Fibroids
Endometriosis (associated with, but not caused by, ditto PID)
Endometrial polyps
Endometrial carcinoma (vascular areas, polyps)
Dysfunctional uterine bleeding
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9
Q

Iatrogenic causes of menorrhagia

A

IUCD

Oral anticoags

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10
Q

Blood tests for menorrhagia

A

FBC

maybe TFTs, clotting

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11
Q

Mx menorrhagia

A

first-line: IUCD

second-line: tranexamic acid, mefanamic acid (and other NSAIDs)

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12
Q

Cervical causes of IMB/ PCB

A

Cervicitis
Cervical polyps
Ectropion
Malignancy

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13
Q

Intra-uterine causes of IMB/ PCB

A 
Polyps
Fibroids (submucuous)
Endometrial hyperplasia
Endometrial malignancy
Endometritis
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14
Q

Hormonal cause of IMB/ PCB

A

Breakthrough bleeding

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15
Q

Causes of PCB (by organ)

A

Ovary (rare): malignancy

Uterus: submucuous fibroid, polyps, endometrial hyperplasia, atrophic changes

Cervix: atrophic changes, malignancy

Vagina: atrophic changes

Urethra: haematuria

Vulva: vulvitis, malignancies, atrophic changes

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16
Q

at what age, is it considered primary amenorrhea

A

pre-16

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17
Q

What is Asherman’s syndrome?

A

a condition characterized by adhesions and/or fibrosis of the endometrium particularly but can also affect the myometrium

caused during Top curretage

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18
Q

Meds causing amenorrhoea (hyperprolacinaemia)

A 
Antipsychotics	Phenothiazines
Haloperidol
Antidepressants	TCAs
Antihypertensives	Methyldopa
Reserpine
Oestrogens	COCP
H2-receptor Antagonists	Cimetidine
Ranitidine
Metoclopramide 
Domperidone
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19
Q

What may be cause of:

breasts without pubic/axillary hair

A

androgen insensitivity

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20
Q

What may be cause of:

- poor breast development with normal hair or hirsutism

A

high circulating androgens

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21
Q

how does haematocolpos appear

A

blue-coloured bulge at the introitus

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22
Q

how to tell ovarian failure from LH/ FSH

A

will be v high

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23
Q

how to tell hypothalamic amenorrhea or hypogonadotrophic hypogonadism from LH/ FSH

A

v low

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24
Q

how to detect PCOS from LH/FSH

A

LH:FSH ratio is >2.5

ie high LH

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25
if androgen levels v v high, what should be suspected
androgen-secreting tumour
26
why is haematocolpos associated with endometriosis
retrograde menstruation
27
physiological causes of amenorrhoea
preg breastfeeding menopause
28
bloods for amenorrhoea
FSH/ LH testosterone prolactin TFTs
29
what are the health risks to those with amenorrhoea due to low oestrogen states
osteoporosis and IHD | may need COCP or HRT
30
excluding physiological cysts, what are the most common benign ovarian cysts
a germ cell tumour is most common in women under 40 | epithelial cell tumour is most common in older women
31
suspicious signs on US re: ovarian cysts
multilocular cysts – presence of solid areas – evidence of mets – presence of ascites – bilateral lesions
32
what is adenomyosis?
endometrial tissue within myometrium
33
most common sites of endometriosis
ovaries, pouch of Douglas, uterosacral ligaments
34
Quarter of symptoms in endometriosis
secondary dysmenorrhea – deep dyspareunia – pelvic pain – infertility
35
Fibroids in pregnancy - grow or shrink?
GROW
36
How many women with fibroids are asymptomatic?
50%
37
Fibroids ix
* FBC (exclude anaemia from menorrhagia) * U&Es (exclude problems from large fibroids which may be compressing bladder or ureters) * Pelvic USS: identify location of individual fibroids and measure them – may be difficult to distinguish fibroids from ovarian masses, particularly those located in the broad ligament – MRI has become gold standard for differentiating fibroids from other pelvic masses * In some cases, laparotomy only way to be sure * For submucous fibroids, hysteroscopy will be the most accurate method
38
Definition prolapse
protrusion of an organ or a structure beyond its normal anatomical site
39
risk factors ovarian ca
* Increasing age * Nulliparity – late age of first conception – early menarche – late menopause * HRT – treatment with ovulation-induction drugs * Smoking * Obesity * White Caucasian – blood group A – higher socioeconomic status
40
Risk factors for endometrial ca
* Obesity (BMI >29 has three-fold increase) – PCOS – nulliparity – unopposed oestrogen use * Tamoxifen * Genetic syndromes (HNPCC)
41
how can endometrial hyperplasia be managed?
PRE-MALIGNANT Can be treated with progesterone to encourage regression If complex hyperplasia: should consider hysterectomy
42
Ix endometrial ca
gold standard is hysteroscopy and endometrial biopsy (LA or GA) (pipelle biopsy can miss)
43
incidence cervical ca
• Two peaks in incidence: between 30-34 years – and between 80-84 years
44
risk factors cervical ca
* Early age first intercourse * Higher number of sexual partners * HPV infection * Lower socioeconomic group * Smoking * Partner with prostatic or penile cancer
45
risk factors vulval ca
* History of CIN, VIN or HPV * Immunosuppression * Lichen sclerosus (benign skin condition with white plaques and atrophy seen in a figure-8 pattern around the vulva and anus – extragenital plaques may be seen (trunk and back) – associated with autoimmune disorders, eg vitiligo – can be classed as pre-malignant as 4% go on to have vulval squamous cell carcinoma)
46
hirsutism vs virilism
• Virilism is always pathological and is due to increased circulated androgens – diagnosed by: clitoral hypertrophy – breast atrophy – deep voice – male-pattern balding – often accompanied by hirsutism
47
age of menopause
45-55 (average age is 51)
48
why can menopause present with urinary sx?
urethral atrophy
49
HRT for women with womb
oestrogen + progesterone (to avoid endometrial hyperplasia - can come from IUS)
50
Symptoms of PID
may include: - Pelvic pain/ lower abdominal pain (usually bilateral and sometimes radiating to legs) - Deep dyspareunia - Dysmenorrhea - Abnormal or increased discharge - Fever
51
which swabs
- Vulval/ high vaginal swab (HVS): candida albicans, Trichomonas vaginalis - Endocervical/ urethral swab: chlamydia trachomatis, neiserria gonorrhoea
52
moa cocp
* Thinning the endometrium | * Thickens cervical mucus to prevent sperm reaching the egg
53
advantages cocp
* Also has a role in managing: dysmenorrhea – menorrhagia – PMS – controls functional ovarian cysts * Associated with reduced incidence of carcinoma of the ovary and endometrium
54
contraindications cocp
``` • Absolute: - Breastfeeding - Arterial or venous thrombosis - Liver disease - Undiagnosed vaginal bleeding - History of oestrogen-dependent tumour - Recent hydatidiform mole • Relative: - Family history of thrombosis - Hypertension - Migraine - Varicose veins - Over 35 / smokers ```
55
moa pop
* Thinning of endometrium * Thickened cervical mucus * Reduced tubal motility
56
disadvantages pop
* Efficacy is reduced if time of pill-taking delayed by more than 3 hours * Spotting or breakthrough bleeding may not settle * Small increased risk of ectopics
57
disadvantages injection
* Side-effects cannot be removed: headaches – spotty skin – mood changes – breast tenderness * Most women become amenorrhoeic, but heavy unpredictable bleeding patterns can occur * May be a delay in return to fertility by 12-18 months * Prolonged use is associated with increased risk of osteoporosis
58
Moa iud
* Likely to prevent blastocyst implantation * Also a foreign body reaction in the endometrium, affecting gamete viability * Changes in cervical mucus, resisting sperm motility – especially with progestogen-releasing MIRENA * MIRENA also thins endometrium
59
iud disadvantages
* Infection – advisable to do chlamydia test and/or give prophylactic abx – not recommended in nulliparous ladies with multiple partners due to risk of PID * Uterine perforation * Expulsion of IUCD/ IUS – if can’t feel threads can check with xray, US or laparoscopy * Ectopic pregnancy * Menorrhagia with IUCD
60
contraindications iud
* Undiagnosed uterine bleeding * Active/ past history PID * Previous ectopic pregnancy * Previous tubal surgery

Medicine (30 decks)

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