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Medicine > Gynae > Flashcards

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
Q

if androgen levels v v high, what should be suspected

A

androgen-secreting tumour

26
Q

why is haematocolpos associated with endometriosis

A

retrograde menstruation

27
Q

physiological causes of amenorrhoea

A

preg
breastfeeding
menopause

28
Q

bloods for amenorrhoea

A

FSH/ LH
testosterone
prolactin
TFTs

29
Q

what are the health risks to those with amenorrhoea due to low oestrogen states

A

osteoporosis and IHD

may need COCP or HRT

30
Q

excluding physiological cysts, what are the most common benign ovarian cysts

A

a germ cell tumour is most common in women under 40

epithelial cell tumour is most common in older women

31
Q

suspicious signs on US re: ovarian cysts

A

multilocular cysts – presence of solid areas – evidence of mets – presence of ascites – bilateral lesions

32
Q

what is adenomyosis?

A

endometrial tissue within myometrium

33
Q

most common sites of endometriosis

A

ovaries, pouch of Douglas, uterosacral ligaments

34
Q

Quarter of symptoms in endometriosis

A

secondary dysmenorrhea – deep dyspareunia – pelvic pain – infertility

35
Q

Fibroids in pregnancy - grow or shrink?

36
Q

How many women with fibroids are asymptomatic?

37
Q

Fibroids ix

A
  • 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
Q

Definition prolapse

A

protrusion of an organ or a structure beyond its normal anatomical site

39
Q

risk factors ovarian ca

A
  • 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
Q

Risk factors for endometrial ca

A
  • Obesity (BMI >29 has three-fold increase) – PCOS – nulliparity – unopposed oestrogen use
  • Tamoxifen
  • Genetic syndromes (HNPCC)
41
Q

how can endometrial hyperplasia be managed?

A

PRE-MALIGNANT
Can be treated with progesterone to encourage regression
If complex hyperplasia: should consider hysterectomy

42
Q

Ix endometrial ca

A

gold standard is hysteroscopy and endometrial biopsy (LA or GA)
(pipelle biopsy can miss)

43
Q

incidence cervical ca

A

• Two peaks in incidence: between 30-34 years – and between 80-84 years

44
Q

risk factors cervical ca

A
  • Early age first intercourse
  • Higher number of sexual partners
  • HPV infection
  • Lower socioeconomic group
  • Smoking
  • Partner with prostatic or penile cancer
45
Q

risk factors vulval ca

A
  • 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
Q

hirsutism vs virilism

A

• 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
Q

age of menopause

A

45-55 (average age is 51)

48
Q

why can menopause present with urinary sx?

A

urethral atrophy

49
Q

HRT for women with womb

A

oestrogen + progesterone (to avoid endometrial hyperplasia - can come from IUS)

50
Q

Symptoms of PID

A

may include:

  • Pelvic pain/ lower abdominal pain (usually bilateral and sometimes radiating to legs)
  • Deep dyspareunia
  • Dysmenorrhea
  • Abnormal or increased discharge
  • Fever
51
Q

which swabs

A
  • Vulval/ high vaginal swab (HVS): candida albicans, Trichomonas vaginalis
  • Endocervical/ urethral swab: chlamydia trachomatis, neiserria gonorrhoea
52
Q

moa cocp

A
  • Thinning the endometrium

* Thickens cervical mucus to prevent sperm reaching the egg

53
Q

advantages cocp

A
  • 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
Q

contraindications cocp

A 
•	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
Q

moa pop

A
  • Thinning of endometrium
  • Thickened cervical mucus
  • Reduced tubal motility
56
Q

disadvantages pop

A
  • 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
Q

disadvantages injection

A
  • 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
Q

Moa iud

A
  • 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
Q

iud disadvantages

A
  • 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
Q

contraindications iud

A
  • Undiagnosed uterine bleeding
  • Active/ past history PID
  • Previous ectopic pregnancy
  • Previous tubal surgery

Medicine (30 decks)

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