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Big Reece's Little Specialties > Gynae > Flashcards

Gynae Flashcards

1
Q

Total contraindications for COCP

A

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation

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2
Q

Management for PCOS

A

Weight reduction
COCP - helps with managing hirsutism
infertility - weight loss, clomphiene (anti-oestrogen, reduces negative feedback on hypothalamus and pituitary, given on day 2 to 6 of cycle to help follicular development), metformin, gonadotrophin, ovarian diathermy, IVF

S/E of gonadotrophin stimulation = increased risk of multiple pregnancy, OHSS (bloating, abdo pain, vomiting, decreased urine output, ovarian torsion, if severe hypovolaemia, electrolyte imbalance, thromboembolism, ascites, pulmonary oedema)

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3
Q

PCOS features:

A

Increased LH (increased androgens) and insulin (due to resistance, which also increases androgen production)
Excess small ovarian follicles on USS - polycystic ovaries
Obesity
acne
hirstuism
Oligo/amenorrhoea

Ix:
FSH is normal
Anti-mullerian hormone is high

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4
Q

causes of anovulation

A

PCOS
Pregnancy
Hypothalamic hypogonadism (in anorexia, women on diets, athletes, stress)
Kallmann’s syndrome - Gnrh neurones don’t develop (also have anosmia)
Hyperprolactinaemia (usually adenoma or hyperplasia of pituitary –> treat with bromocriptine or cabergoline = Dopamine agonists)
Piuituary damage e.g Sheehan’s syndrome post partum or from tumours
Primary ovarian insufficiency (E2, inhibit lowered, FSH and LH massivly raised, no AMH as no follicles)
Hypo/hyperthyroid

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5
Q

Dermoid Cysts

A

Type of mature teratoma - germ cell tumours
Cyst with normal body tissue in it - hair, teeth, skin etc
Has Rokitansky protuberance
Higher risk of torsion than other cysts

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6
Q

Follicular cyst

A

Most common type of cyst
Caused by non-rupture of the dominant follicle or failure of a non dominant follicle atresia (regression)
Should regress in a few cycles

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7
Q

Serous Cystaednoma/ Carcinoma

A

Ovarian tumour
Serous carcinoma = most common malignancy
Made up of columnar epithelium
Affects women aged 30-40

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8
Q

Mucinous Cystadenoma

A

Mucin secreting cells, like those from endocervical mucosa
Or can be intestinal type –> metastasis from appendix causing pseudomyxoma peritonea
Secretes oestrogen

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9
Q

Ectopic pregnancy symptoms

A

A typical history is a female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding

lower abdominal pain: typically the first symptom. Pain is usually constant and may be unilateral. Due to tubal spasm

vaginal bleeding: usually less than a normal period, may be dark brown in colour

history of recent amenorrhoea: typically 6-8 weeks from start of last period; if longer (e.g. 10 wks) this suggest another causes e.g. inevitable abortion

Abdominal tenderness
Cervical excitation

peritoneal bleeding can cause shoulder tip pain and pain on defecation / urination

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10
Q

Causes of free fluid in the pouch of douglas

A

Ruptured ectopic
PID
Tubo-ovarian abscess
Hydratidform mole

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11
Q

whirlpool sigh

A

Ovarian torsion

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12
Q

Endometriosis signs

A

chronic pelvic pain
dysmenorrhoea - pain often starts days before bleeding
deep dyspareunia
subfertility
non-gynaecological: urinary symptoms e.g. dysuria, urgency, haematuria. Dyschezia (painful bowel movements)
on pelvic examination reduced organ mobility, tender nodularity in the posterior vaginal fornix and visible vaginal endometriotic lesions may be seen

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13
Q

COCP increases risk of which 2 cancers

A

Breast

Cervical

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14
Q

COCP decreases the risk of which 2 cancers

A

Ovarian

Endometrial

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15
Q

How long until the COCP is affective if not first day of period

A

Contraceptives - time until effective (if not first day period):
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

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16
Q

How long until POP is effective if not first day of period

A

Contraceptives - time until effective (if not first day period):
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

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17
Q

Symptoms of a ruptured ovarian cyst

A

sudden onset unilateral pelvic pain precipitated by intercourse or strenuous activity
Ultrasound shows free fluid in the pelvic cavity.

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18
Q

Symptoms of a ovarian torsion

A

sharp unilateral pain often associated with nausea and vomiting.
There is a tender palpable adnexal mass on bimanual exam.
Ultrasound shows an enlarged, oedematous ovary with impaired blood flow.

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19
Q

Features of adenomyolysis

A

dysmenorrhoea
menorrhagia
enlarged, boggy uterus

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20
Q

Treatment for adenomyolysis

A

Gnrh agonists

Hysterectomy

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21
Q

how long can you use levonorgestrel for, how does it work

A

72hrs

its a progesterone so inhibits ovulation and increases cervical mucus

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22
Q

What is Ella one and how long can you use it for

A

Ulipristal acetate

up to 5 days

23
Q

What can you use for emergency contraception that isn’t a pill, and when is it effective

A

IUD (copper)

5 days after unprotected sex or up to 5 days after likely last ovulation date

24
Q

When do you have to stop the COCP for surgery and when can you start it again

A

Stop 4 weeks before

start 2 weeks after surgery

25
Q

what does atrophic vaginitis present with

A 
dryness pain (dyspareunia), some spotting
Pale and dry vagina
26
Q

Rx atrophic vaginitis

A

Give topical oestrogen cream

use lube and moisturisers

27
Q

Missed POP pill - Micronor, Noriday, Nogeston, Femulen
Missed POP Pill - Cerazette (desogestel)

What do you do?

A

Traditionals -less than 3 hours, take it and continue as normal
More than 3 hours late - take next pill ASAP then continue as normal with rest of pack, use condoms for 48 hours

Cerazette is 12 hours instead of 3

28
Q

Symptoms of Ovarian Cancer

A 
abdominal distension and bloating
abdominal and pelvic pain
urinary symptoms e.g. Urgency
early satiety
diarrhoea
29
Q

Ix for ovarian Cancer

A

Ca125
If raised >35, urgent USS of the abdomen and pelvis
Diagnostic laparotomy

30
Q

Most common ovarian cancer & what type of cell

A

Serous Carcinoma, Epithelial

31
Q

Risk factors for ovarian cancer

What commonly used medication decreases the risk

A

BRCA1 and 2
Many ovulations - early menarche, late menopause, nuliparity

COCP decreases risk

32
Q

Causes of menorrhagia

A

dysfunctional uterine bleeding: this describes menorrhagia in the absence of underlying pathology. This accounts for approximately half of patients

PAINFUL, normal cycle
Endometriosis
Adenomyolysis
PID

PAINLESS, normal cycle:
FIbroids
bleeding disorders, e.g. von Willebrand disease
Consider endometrial cancer and polyps

Long cycle >35 days or Short cycle <21 days
anovulatory cycles: these are more common at the extremes of a women’s reproductive life
Consider prolonged COCP course

Other
hypothyroidism
intrauterine devices - copper coil

33
Q

Stress incotinence treatment

A

pelvic floor muscle training: NICE recommend at least 8 contractions performed 3 times per day for a minimum of 3 months
surgical procedures: e.g. retropubic mid-urethral tape procedures

Colposuspension
Sling procedures
Intramural bulking agents

34
Q

Urge incotinence treatment

A 
reduce caffeine, intake, weight
bladder retraining (lasts for a minimum of 6 weeks, the idea is to gradually increase the intervals between voiding)
bladder stabilising drugs: antimuscarinics are first-line.

NICE recommend oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation).

Immediate release oxybutynin should, however, be avoided in ‘frail older women’
mirabegron (a beta-3 agonist) may be useful if there is concern about anticholinergic side-effects in frail elderly patients

Overactive bladder can be treated with botulin trigger point injections, percutaneous sacral & posterior tubular nerve stimulation

35
Q

what is linked with cervical ectropion, and what are the symptoms

A

Oestrogen - COCP, pregnancy etc –> increases columnar epithelium at the transition zone of the cervix

Causes post coital bleeding and PV discharge

36
Q

Risk factors for cervical cancer

A 
smoking
human immunodeficiency virus
early first intercourse, many sexual partners
high parity
lower socioeconomic status
combined oral contraceptive pill*
37
Q

What section of the menstrual cycle is variable?

A

The follicular phase of the menstrual cycle can be variable, however, the luteal phase (after ovulation) remains constant at 14 days.

38
Q

uterus big for gestational age, hyperemesis and PV bleeding

Dx?

A

Hydratidform mole

39
Q

Rx for hydratidform mole

A

ERPC,
Serial monitoring of bHCG in specialist centre
methotrexate if rising stagnant BHCG
avoid pregnancy for 6m

40
Q

how long should pregnacy be avoided for after a molar pregnancy

A

6m

41
Q

woman presents with pyrexia, tachycardia, lower abdo tenderness, offensive discharge, uterine and adenexal tenderness after her C section.

What is it and what do you do?

A

Endometritis,

broad spec Abx

42
Q

If a woman has post-coital bleeding, what should be ruled out, and what are other causes

A

Cervical Cancer

Cervical ectropion
Cervical polyp
vaginal trauma
vaginal atrophy

43
Q

what causes a strawberry cervix and frothy/thin green/yellow offensive discharge
with itching, soreness etc

A

Trichomonas Vaginals

44
Q

what happens to fibroids in pregnancy and what are the symptoms

A 
red degeneration (coagulative necrosis 
Pain,uterine tenderness
45
Q

what happens to fibroids post-menopausal

A

Often regression

Calcification

46
Q

was is the risk malignancy index used for and what does it involve

A

USS
enopausal status
Serum Ca125

47
Q

what are the symptoms of ovarian cancer

A

Bloating
feeling full/early saitey or loss of apetite
pelvic/abdo pain
Increased urgency and frequency of urination
Similar to IBS - but IBS shouldn’t present in an older woman

48
Q

what genes increase risk of ovarian cancer

A

BRCA1+2

HNPCC

49
Q

what is the treatment for a bartholin cyst/abscess

A

Incision, drainage and marzupilisation

50
Q

FIGO staging general overview of stages (ovarian)

A

1 - in the ovaries (a if 1 ovary, b if 2, c if ruptured capsule/positive periotneal washings/positive ascities)

2- Into the pelvis - fallopian tube, uterus

3- abdominal disease/LN (omentum, SI, peritoneum)

4- beyond the abdomen - lung, liver

51
Q

what are the signs of asherman’s syndrome

A 
Menstural distubrances (often amenorrhoea)
cyclical abdominal pain
Subfertility
52
Q

Gold standard for diagnosing endomeriosis

A

Laproscopy

53
Q

Mittelschmerz

A 
Usually mid cycle pain.
Often sharp onset.
Little systemic disturbance.
May have recurrent episodes.
Usually settles over 24-48 hours.

Big Reece's Little Specialties (4 decks)

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