Gynae Flashcards

1
Q

Endometriosis symptoms

A

Dysmenorrhoea (cyclical, just before start of bleed)
Menorrhagia
Deep dyspareunia

Infertility

Dyschezia
Urinary symptoms

Many incidental findings

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2
Q

Endometriosis demographics

A

Reproductive age

Nulliparous

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3
Q

Endometriosis investigations

A

TvUSS
Laparoscopy is gold standard
Endoscopic rectal US is good too

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4
Q

Endometriosis non-fertility sparing Mx

A

Treat if symptomatic.
Conservative - Mefanamic acid + paracetamol

Induce menopause:

COCP
IUS
POP
GnRH agonist

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5
Q

Endometriosis fertility sparing

A

GnRH agonists to shrink lesions + laparoscopic surgery for mild disease improves fertility.

Scarce evidence to suggest it helps fertility in more severe disease.

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6
Q

Endometriosis complications and prognosis

A

Most therapies help symptoms

35% remain infertile

Increased risks of:
Ovarian cancers
adhesions (esp. if surgical Mx)
IBD

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7
Q

Endometriosis definition

A

Endometrial stroma and glands found outside the uterus.

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8
Q

Common sites for endometriosis

A

Fallopian tubes!!
Ovaries (endometrioma)
Pouch of Douglas
Ligaments, colon, bladder, ureter.

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9
Q

Definition of fibroids

A

Leiomyoma - benign tumours of smooth muscle and connective tissue

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10
Q

Fibroids patient demographics

A

30-50
Afro-Caribbean
Overweight and early menarche (raised Oest exposure)

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11
Q

Fibroids classifications

A

Intramural (majority)

Submucosal - growing into uterine cavity (may be pedunculated or poke through cervix)

Subserosal - Growing outwards from uterus

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12
Q

Fibroids presentation

A

Most asymptomatic

30% - menorrhagia
dysmenorrhoea
central pelvic mass
bloating

uncommonly: infertility(submucosal), urinary symptoms, pain (if torted/degenerating)

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13
Q

Investigations for fibroids

A

TvUSS (assess distortion of uterine cavity!)
pelvic USS
MRI
Endometrial biopsy

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14
Q

Mx of fibroids - non fertility sparing

A

Conservative - Tranexamic acid + paracetamol

Hormonal:

1) IUS (if no distortion of cavity on USS)
COCP
UPA

2) GnRH agonist

Surgical:

UAE
Hysterectomy

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15
Q

Mx of fibroids for fertility

A

1) Hysteroscopic removal of submucosal fibroids if <3cm

2) Laparoscopic myomectomy

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16
Q

Complications of fibroids

A

IDA
Infertility

Red degeneration - Due to inadequate blood supply. Commonly during pregnancy.

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17
Q

Malignant form of fibroids

A

Leiomyosarcoma - 0.1% of fibroids

18
Q

What is adenomyosis?

A

Presence of endometrial tissue within the myometrium

19
Q

Presentation of adenomyosis?

A

Enlarged, tender uterus
Menorrhagia
Dysmenorrhoea

20
Q

Ix adenomyosis

A

MRI is the best

21
Q

Mx adenomyosis

A

IUS or COCP

Hysterectomy if severe/fertility not an issue

22
Q

Endometritis can occur after?

A
Post partum - especially C section
Prolonged rupture of membranes
Manual removal of placenta
TOP
Uterine surgery
23
Q

Presentation of endometritis?

A
Fever
Abdo pain
Foul smelling lochia/discharge
PV bleeding
Tachycardia
24
Q

Management of menorrhagia

A

Conservative: tranexamic acid (and mefanamic if painful)

Hormonal:

1) IUS
2) COCP
3) Progestogens (oral or IM)

25
Q

Causes of primary amenorrhoea

A
Turner's - short, webbed neck, wide spaced nipples
Constitutional delay
PCOS 
AIS
Mullerian abnormalities
Chronic illness
26
Q

Causes of secondary amenorrhoea

A

Hypothalamic - anorexia, excess exercise

Pituitary - prolactinoma, Sheehan’s

Hypo/hyperthyroid

CAH

Ovarian - PCOS, POI

27
Q

Types of amenorrhoea?

A

Primary - never menstruated
secondary - no periods for 6 months

Oligomenorrhoea - cycle varies between 35 days and 6 months

28
Q

Causes of post-coital bleeding

A

Cervical carcinoma
Cervical polyps
Cervicitis (STI)
Ectropion - Most common. More when pregnant or on COCP

29
Q

Treatment of ectropion?

A

Cryotherapy

30
Q

Causes of PMB

A

Most common - atrophic vaginitis

Endometrial hyperplasia
Endometrial Ca
Ovarian Ca
Polyps

31
Q

Investigations for PMB

A

All women with abnormal PV bleed after age of ?40 TvUSS for endometrial thickness

32
Q

Above what thickness endometrium do you Ix further?

A

Hysteroscopy with pipelle biopsy if >4mm

33
Q

Symptoms of PMS

A

Psychological - depression, anxiety, mood swings

Physical - Bloating, mastalgia

Symptoms free week before ovulation!
Symptoms worse during luteal phase

34
Q

Ix of PMS

A

Daily Record of Severity of Problems (DSRP) for 2 cycles.

Exclude organic cause: FBC, TFT, vit D

35
Q

Mx of PMS

A

Exercise helps

1) COCP - continuous regimen

CBT or SSRI for severe psychological sx

Danazol - mastalgia

36
Q

PID presentation

A

Lower abdominal pain
Deep dyspareunia
PV bleeding
Purulent discharge

37
Q

classic exam finding in PID

A

Cervical excitation (!!!)

38
Q

Organisms in PID

A

Chlamydia trachomatis
Neisseria gonorrhoea
Mycoplasma genitalium

39
Q

Ix of PID

A

Endocervical swabs for chlam/gonorr

Pelvic USS- exclude cysts or abscess

40
Q

Mx of PID

A

IM cef 250mg + PO metro 500mg + PO doxy 100mg

41
Q

Complications of PID

A

Tubal damage
Adhesions
Hydro/pyosalpinx due to obstruction

Subfertility

42
Q

Ix for amenorrhoea

A

You BETTER GO PRO AND check EAST THYROID!

  • BETA-HCG
  • GOnadotrophins
  • PROlactin
  • ANDrogens
  • oESTradiol
  • THYROID function