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Gynae Flashcards

1
Q

Stress incontinence

Definition
Aetiology 
Presentation 
Investigations 
Management
A

Involuntary loss of urine on increased intra-abdominal pressure - when the detrusor pressure is > closing urethral pressure

Aetiology

  • Pregnancy/ childbirth
  • Radiotherapy
  • Age - post menopausal due to the lack of oestrogen
  • Fam Hx
  • Infection?
  • Obesity

Presentation
Involuntary loss of urine on increased intraabdominal pressure
- Coughing/ laughing/ straining/ sneezing/ lifting

Investigations

  • MSU - check infection
  • Frequency volume chart - normal frequency and bladder capacity
  • Urodynamics

Management
1) Conservative
Reduce caffeine and fluid intake, pelvic floor exercises, reduce RF eg weight loss/ control diabetes - 3 months

2) Duloxetine - SNRI
3) Surgery - TVT/ periurethral injections

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2
Q

Management stress incontinence

A

Management
1) Conservative
Reduce caffeine and fluid intake, pelvic floor exercises, reduce RF eg weight loss/ control diabetes - 3 months

2) Duloxetine - SNRI
3) Surgery - TVT/ periurethral injections

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3
Q

Overactive bladder

Definition
Aetiology 
Presentation 
Investigations 
Management
A

Definition
Overactive detrusor muscle

Aetiology

  • Obesity
  • Neuro - parkinson’s/MS/diabetes

Presentation
^urgency, frequency, nocturia, key in door

Investigations

  • MSU - check infection
  • F/V chart - ^F and urgency
  • Urodynamics - cystometry shows ^ detrusor muscle activity when stimulated eg filled

Management

1) Conservative - pelvic floor, bladder retraining, CBT, reduce RFs, lose weight
2) Pharmacological
- Oxybutynin - Anti Ach (NOT in frail elderly)
- Mirabegron B3 agonist
- Botox injections

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4
Q

Side effects of Anti Ach

A 
Dry mouth 
Blurred vision 
Constipation 
Urinary retention 
Drowsiness 
Cognitive impairment
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5
Q

Management of overactive bladder

A

Management

1) Conservative - pelvic floor, bladder retraining, CBT, reduce RFs, lose weight
2) Pharmacological
- Oxybutynin - Anti Ach (NOT in frail elderly)
- Mirabegron B3 agonist
- Botox injections

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6
Q

Prolapse

Aetiology 
Types 
Presentation 
Grading 
Investigations 
Management
A 
Aetiology 
- Childbirth 
- Age 
Radiotherapy
- Chronic pressure 
Obesity 
Pelvic mass 
Chronic cough 
Constipation 
Types 
- Cystocoele 
bladder into ant vagina 
- Rectocoele 
Rectum into post. vagina 
- Vault 
Upper vagina --> lower 
- Uterine 
Uterus --> vagina 
- Cystourethrocoele 
bladder + Urethra into vagina 
- Enterocoele (higher than R)
Small intestines and peritoneum (can include PoD)

Presentation

  • Bearing down, dragging sensation
  • Urinary symptoms
  • Sexual dysfunction
Grading 
0 - no protrusion
I - to 1cm above hymen
II - 1cm + or below hymen 
III - >1cm below hymen - no vaginal eversion 
IV - + vaginal eversion

Management

  • Pelvic floor exercises
  • Ring pessary
  • Oestrogen
  • Surgery - colporrhaphy
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7
Q

Chlamydia

Aetiology 
Presentation 
Investigations 
Management 
Complications
A 
Aetiology 
Chlamydia trichomonas (gram -ve cocci) 
Presentation 
Females 
- Dysuria
- Discharge 
- IMB
Males 
- Dysuria
- Discharge

Investigations

  • NAAT
  • Urine sample or endocervical swab

Management
- Azithromycin IM 1 dose
(contact trace)

Complications 
PID (FHCS) + subfertility 
Ectopic 
Others:
Reactive arthritis 
Epdidymitis 
Cervicitis
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8
Q

Gonorrhoea

Aetiology 
Presentation 
Investigations 
Management 
Complications
A 
Aetiology 
Nesseria G (g neg dippy)

Presentation
Same as chlamydia

Investigations
NAAT

Management
IM ceftriaxone

Complications 
PID - FHCS + subfert 
Ectopic 
Arthritis 
Tenosynovitis 
Dermatitis
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9
Q

Herpes

Aetiology 
Presentation 
Investigations 
Management 
Complications
A

Aetiology
HSV 1 and 2 (mainly 2)

Presentation 
Painful ulcers 
Dysuria 
Fever/ myalgia 
Lymphadenopathy

Investigations
Swab + PCR

Management
Acyclovir 5 days

Complications
Urinary retention
Pregnancy - neonatal herpes
elective CS if >28w with active infection
Can Rx with suppression therapy if recurrent

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10
Q

Candida

RF
Aetiology 
Presentation 
Investigations 
Management 
Complications
A 
RF
Immunosuppression 
Steroids 
Diabetes 
Broad spec abx

Aetiology
Candida albicans

Presentation 
Cottage cheese discharge 
Red swollen vulva 
itching 
Pain - dyspareunia

Investigations
HVS - mainly clinical diagnosis

Management
- PO: fluconazole
- Topical clotrimazole
ORAL NOT IN PREGNANCY

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11
Q

Bacterial vaginosis

Aetiology
Presentation
Investigations
Management

A

Not strictly an STI - overgrowth of anaerobes when low lactobacillus - can get from douching

Aetiology
Gardanella vaginosis

Presentation
Grey thin fishy discharge

Investigations 
Amsel's criteria 
- pH high >4.5 
- Whiff test +ve 
- Grey fishy discharge 
- Clue cells on microscopy

Management
PO metronidazole

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12
Q

Trichomonas vaginalis

Aetiology
Presentation
Investigations
Management

A

Aetiology
Trichomonas vaginalis

Presentation

  • Green frothy discharge
  • Strawberry cervix
  • Itching and dysuria
  • pH high

Investigations
Wet mount - PMNLs

Management
PO: metronidazole

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13
Q

Genital warts

Aetiology 
Presentation 
Investigations 
Management 
Complications
A

Aetiology
HPV 6, 11

Presentation
fleshy protuberances - no pain/ itching

Investigations
- swab for PCR

Management
Cryotherapy/ imiquimod

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14
Q

Syphilis

Aetiology 
Presentation 
Investigations 
Management 
Complications
A

Aetiology
Treponema pallidum

Presentation
Primary
Chancre/ lymphadenopathy

Secondary

  • Condylomata lata
  • Buccal snail tracks
  • Fever/ malaise/ etc

Tertiary

  • Gummas - nodules
  • Neuro
  • Argyll robertson pupil (constrict to accomodate but not to light)
  • CV - anuerysms

Investigations
- Blood serology

Management
- IM ben pen

Complications - tertiary + teratogenic (miscarriage + still birth)

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15
Q

Triple swabs

A

Endocervix - chlamydia

Endocervix charcoal - C + G

HVS

  • GBS
  • Fungal
  • TV, BV
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16
Q

Fibroids

Definition
Types
Aetiology 
Presentation 
Investigations 
Management 
Complications
A

Definition: benign proliferation of smooth muscle

Types 
Pedunculated 
Intramural 
Subserosal 
Submucosal 
Intracavetine

Aetiology

  • Respond to oestrogen
  • Afrocaribbean
  • Child bearing age
  • Do not progress beyond menopause - just calcify
  • Can grow (or shrink) in pregnancy
Presentation 
- Dysfunctional bleeding - main
Menorrhagia 
Can be  IMB/ dysmenorrhoea 
Subfertility 
Mass effect

Investigations

  • TVUS
  • FBC can be ^ or low (erythropoetin or anaemia)
Management 
Mirena coil 
Other 
- TXA/NSAIDS
- progesterones 
- COCP 
>3cm - ullipristal acetate 
Surgery - myomectomy (if they want to conceive), ablation, hysterectomy, uterine artery embolisation 
Complications 
- Subfertility 
- Degeneration 
- Pregnancy 
prem labour 
obstructed labour 
malpresentation 
PPH
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17
Q

Complications of fibroids

A 
Subfertility 
Degeneration 
Hyaline, cystic
RED - in pregnancy, vomiting, abdo pain, fever 
Torsion of pedunculated 
Pregnancy 
- Prem labour 
- Obstructed labour 
- Malpresentation 
- PPH
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18
Q

Management of fibroids

A 
MIRENA COIL FIRST IN LINE 
Others 
- COCP 
- Progesterones 
- TXA/NSAIDS

Ullipristal acetate

Surgical 
Myomectomy - if want to conceive 
Ablation 
Hysterectomy 
UAEmbolisation
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19
Q

Firboids
Main presentation and investigations
one answer each

A

Menorrhagia

TVS

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20
Q

Adenomyosis

Definition
Aetiology 
Presentation 
Investigations 
Management
A

Definition
Endometrium in the myometrium

Aetiology
Older women

Presentation
Dysfunctional bleeding
- Dysmenorrhoea, menorrhagia
BOGGY UTERUS

Investigations
- MRI

Management

  • GnRH analogue
  • Hysterectomy
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21
Q

Endometrial hyperplasia

A

Abnormal proliferation of the endometrium not in keeping with the menstrual cycle

Can be a precursor to malignancy

Presents as dysfunctional bleeding

Typical -> progestogens/ mirena

Atypical –> hysterectomy

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22
Q

Endometriosis

Definition 
Aetiology 
Presentation 
Investigations 
Management 
Complications
A

Endometrium found outside the uterine cavity
- commonly ovary/ uretosacral ligament

Aetiology

  • unknown
  • retrograde menstruation and impaired immunity
  • genetic
Presentation 
PAIN - day before period 
- dysmenorrhoea 
- dyspareunia (deep) 
- Dyschezia + GI symptoms 
- Urogen - dysuria 
SUB-FERTILITY

Investigations
- Laparoscopy and biopsy = gold standard - chocolate cysts (obvs can do TVUS if suspect others)

O/E

  • Fixed retroverted uterus
  • Reduced organ mobility
  • Tender nodules in posterior fornices

Management

  • Symptom relief
  • abolish cyclicity - COCP/ progesterones/ mirena
  • GnRH
  • Ablation
  • SO

Complications

  • Subfertility (+/e adhesions)
  • Ectopic pregnancy
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23
Q

Presentation of endometriosis

A

PAIN
(dyspareunia, dysmenorrhoea, dyschezia, urogen symptoms, lower back pain)
SUBFERTILITY

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24
Q

investigations of endometriosis

A

Laparoscopy and biopsy

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25
Q

Endometrial cancer

A

Epidemiology
- Post menopausal women - 75%

Aetiology 
Unopposed oestrogen - like Br
- COCP protective 
- Early menarche, late menopause, nulliparity 
- Age 
- Obesity 
- PCOS 
- Tamoxifen
- HNPCC

Pathophysiology
- Adenocarcinoma

Presentation
- PMB - MAIN
Other - IMB, systemic eg weight loss
Pyometra

ANY PMB IN >55 - go for TVUS to assess endometrial thickness

Investigations
TVUS - endometrial thickness >4mm –> urgent biopsy

CT staging

Staging + Management
FIGO
I - endometrium
Hysterectomy + BSO

II + cervix
Radical hysterectomy

III + serosa, para-aortic, pelvic nodes
Hysterectomy + Radio/ chemo

IV - bowel/ bladder/ distant mets
Hysterectomy + radio/chemo

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26
Q

PMB ∆∆

A

Vaginal atrophy - MOST COMMON
HRT - can –> spotting

Endometrial cancer - MOST WORRYING
Endometrial hyperplasia

ovarian cancer
ovarian cyst

Cervical cancer
Cervicitis

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27
Q

Intrauterine cyst

A

Like fibroids grow in response to oestrogen - Obesity

Present: dysfunctional bleeding

Can cause subfertility

Rx

  • Curettage
  • Diathermy
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28
Q

Cervix anatomy (histology)

A

Uterus

Endocervix - ciliated columnar

Transformational zone - most prone to malignant ∆ - squamocolumnar junction

Ectocervix - Squamous

Vagina

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29
Q

Cervicitis

Cause
Presentation
Management

A

Infection eg chlamydia

Presentation: PCB

Management: Rx infection eg abx
Cyrotherapy

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30
Q

Cervical ectropion

A

Endocervix –> ectocervix –> PCB

Culprit - COCP, pregnancy

Management - swap contraception
Cyrotherapy

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31
Q

Cervical polyp

A

IMB/PCB

Avulsion

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32
Q

Cervical screening
Who
Results and meaning

A

25-49 - 3 yearly
50-64 - 5 yearly

Inadequate - repeat up to 3 times then send to colp

Borderline - HPV test - if -ve - back to normal routine, if +ve, colp

CIN I (mild) or above –> urgent colp

If treated for CIN I or above –> repeat smear in 6 months

If they are immunocompromised - annual smear

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33
Q

Been treated for CIN I - when is their next smear

A

6 months time

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34
Q

Who is eligible for cervical screening

A

25-49 - 3 years

50-64 - 5 years

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35
Q

CIN

What is it 
RF 
Presentation 
Grading 
Investigations 
Management
A

Cervical intraepithelial neoplasia

Atypical cells found within the epithelium - SQUAMOUS

RF
- HPV 16,18,33
Smoking, immunocompromised, ^sexual partners

Presentation
- PCB

Grading
I - 1/3
II 2/3
III >2/3- Carcinoma in situ

Invasion of basement membrane –> MALIGNANCY

Investigations
- Punch biopsy

Management
- LLETZ

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36
Q

HPV strains involved in CIN + cancer

A

16, 18, 33

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37
Q

Cervical cancer

Aetiology 
Histology 
Presentation 
Investigations 
Staging + management
A

Aetiology
HPV - see CIN

Pathophysiology
Squamous cell carcinoma

Presentation
PCB

Investigations
Colposcopy

Staging and management 
I - cervix 
IIa + upper vagina 
IIb + parametrium 
III + pelvic wall 
IV + bowel + bladder 
Management 
Iai - cone biopsy 
Iaii - 2a -
wertheim's hysterectomy 
Pelvic nodes? - hysterectomy + chemo/radio 
2a + - Hysterectomy radio, chemo
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38
Q

Ovarian cysts - types

A 
Main
Physiological 
- Follicular - MAIN TYPE 
Common in childbearing age 
- CL

Benign germ cell
dermoid cyst

Benign Sex cord

Benign epithelial
- Serous cystadenoma - solid 40-50y/o can be malignant

  • mucosal
    Fibroma
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39
Q

Ovarian cyst

Presentation

A

Mass effect

  • Bloating
  • Early satiety
  • Constipation
  • Back pain
  • Dyspareunia
  • Urinary symptoms
  • PCB
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40
Q

Ovarian cyst

Investigations

A

TVUS - main

Laparotomy + FNA to confirm

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41
Q

Ovarian cyst

management

A

Pre menopausal
<5cm Watch and wait
>5cm Laparoscopic ovarian cystectomy

Post menopausal
<5cm Watch and wait
>5cm Hysterectomy

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42
Q

Complications of ovarian cyst

A

Torsion
Rupture –> peritonitis
Haemorrhage

43
Q 
Ovarian torsion 
Aetiology 
Presentation 
Investigation 
Management
A

Aetiology
Pregnancy
Cancer
Cyst

Presentation
Fever
Abdo pain
Vomiting

Investigation
TVUS
- free fluid - whirlpool sign
Laparoscopy is diagnostic and therapeutic

Management - laparoscopy

44
Q

Boggy uterus

A

Adenomyosis

45
Q

Bulky uterus + dysfunctional bleeding

A

Fibroids

46
Q

Ovarian cancer

Aetiology 
Histology 
Presentation
Investigations 
Staging + Management
A 
Aetiology 
Same as breast 
BRCA 
- Unopposed oestrogen culprits 
- HNPCC 
- Obesity

Histology
Serous carcinoma

Presentation
Mass effect 
- Dyspareunia 
- Bloating/ early satiety 
- Urinary symptoms 
PCB

Investigations
Ca125 if >35 —> urgent USS
RMI
Biopsy/ CT

Staging + Management 
I - ovary 
II - Pelvis 
III - bowel bladder 
IV - distant mets

management
- Surgery, platinum chemo + radio

WOMEN WITH NEW IBS >50 –> CA125

47
Q

RMI calculation

A 
U x M x 125 
U
BAMMS 
Multi-ocular cysts - 1 
Ascites - 3 
Bilateral lesions - 3 
Mets - 3 
Solid areas - 3

M

  • pre - 1
  • post - 3

> 250 –> MDT + CT

48
Q

Women >55 with PMB

A

sent for URGENT referral - TVUS - to look at endometrial thickness

49
Q

Staging ovarian

A

I - ovary
II - pelvis
III - bowel/bladder
IV - mets outside abdomen

50
Q

Hyatidiform mole

Aetiology/ RF 
Presentation 
Investigations 
Management 
Complications
A

Aetiology/ RF
Extreme age, asian, previous

Presentation

  • Hyperemesis gravidarum
  • Painless bleeding

Thyroid^ (bhCG mimics)
Proteinuria
HTN

Investigations 
- b-hCG ^^^ 
- Proteinuria 
- HTN 
USS - snowstorm, honeycomb, bunch of grapes

Management

  • Methotrexate
  • Surgical TOP

Complications
- Choriocarcinoma

51
Q

PMB ∆∆

A

ANY woman >55 with PMB should get urgent TVUS to assess thickness of endometrium

Vaginal atrophy
HRT

Endometrial cancer
Endometrial hyperplasia

Ovarian Ca
Ovarian cyst

Cervical cancer
Cervicitis

Vulval cancer

52
Q

Menorrhagia

Causes
Investigations
Management

A 
Causes 
Idiopathic - 50% 
Uterine 
- Fibroids - 30%
- Polyps

Systemic - thyroid, bleeding disorders, diabetes

Drugs

  • Anticoags
  • IUD
Investigations 
ALL should have an FBC 
Then others if indicated in the Hx eg 
TVUS 
TFT 
Coag screen 
LFTs
Management 
Do they want to conceive 
No: 
Mirena coil 
COCP

Yes:
- TXA/ Mefenamic acid for pain

Other: surgery

  • UAEmbolisation
  • Ablation
  • hysterectomy
53
Q

Dysmenorrhoea

Aetiology
Maangement

A 
Endometriosis 
Adenomyosis 
Idiopathic 
Fibroids 
Ovarian cyst/Ca 
PID / adhesions 
Copper IUD

Management

  • Rx cause
  • Medfanamic acid
  • TENS
  • COCP
54
Q

IMB

A 
Fibroids 
Polyps 
Adenomyosis 
Ovarian cyst 
Endometrial/cervical/ovarian  cancer

Rx - COCP

55
Q

Vulval cancer

RF 
Histology 
Presentation 
Investigations 
Management
A

RF

  • HPV + friends
  • LICHEN SCLEROSUS

Histology
- SCC

Presentation

  • Itch
  • Bleed
  • Dyspareunia
  • Ulcer/mass
  • Discharge

Investigations
- Biopsy

Management
- Surgical excision +/e groin lymphadenopathy / radio/chemo

56
Q

Lichen simplex

A

Chronic inflammatory skin contrition

itching
Inflamed thick labia majora

RF - dermatitis/atopy

Rx steroid, antihistamines

57
Q

Lichen planus

A

Associated with autoimune conditions

Purple
Oral and genital
Painful not itchy

Rx steroids

58
Q

Lichen sclerosus

A

Autoimmune association

Paper white/grey
thin skin
Itching and dyspareunia

associated with SCC

Rx steroids

59
Q

Vaginal cancer

A

SCC

Painful, discharge, dyspareunia

Rx - radio/chemo

60
Q

Atrophic vaginitis

A

In menopause due to less oestrogen

Itching
Painful 
Dryness 
Dyspareunia 
PMB

Rx
Lubricants
Topical oestrogen

61
Q

Acute pelvic pain ∆∆

A 
Ectopic (until proven otherwise) 
Ovarian torsion 
Ovarian cyst rupture 
Miscarriage 
PID 
UTI 
Appendicitis

Ectopic - cervical excitation, period of amenorrhoea, PV bleed - brown

Ovarian torsion - fever, vomiting

Ovarian cyst rupture

Miscarriage
PID - cervical excitation, symptoms of STI, deep dyspareunia

UTI - urinary symptoms

Appendicitis - rebound tenderness + friends

62
Q

Chronic pelvic pain ∆∆

A 
Endometriosis 
Adenomyosis 
Ovarian cyst 
Adhesions 
PID 
IBS/IBD
Psychological
63
Q

PID

Aetiology/ RF 
Presentation 
Investigations 
Management 
Complications
A

Aetiology
- STI - usually chlamydia

Presentation

  • Pelvic pain
  • Fever
  • STI symptoms
  • Deep dyspareunia
  • RUQ pain if FHCS
  • Cervical excitation O/E!!!

Investigations
- HVS
Others if indicated in Hx

Management
Ceftriaxone, oral doxy + oral metronidazole

Complications

  • ectopic
  • subfertility
  • chronic pelvic pain
64
Q

Menopause

Definition
Symptoms

A

Definition
Permanent cessation of periods for 12 months due to follicle end

Symptoms
1) Vasovagal
Hot flushes/ night sweats/ mood swings

2) Vaginal
Dryness/ itching/ irregular cycle/ DMB

3) UROGEN
Incontinence/ prolapse/ freq etc ^UTI

Long term (/risks)
1) Osteoporosis
2) CV events 
3) Psych/neuro 
Dementia/depression/ anxiety
65
Q

Menopause - when to use contraception

A

<50 - 24 months
>50s for 12 months

After last period

66
Q

Menopause

When
What investigations

A

When

  • <40
  • atypical symptoms
  • Consider in 40-45

FSH^
taken 2-5 day of cycle - 2 samples, 4 weeks apart

AMH ^
- taken at any time

other

TFT
Catecholamines
LH
oestradiol

67
Q

Fraser criteria

A 
Understand the information 
Will continue to have sex 
Has tried to persuade to tell her parents 
Her health might be at risk 
In her best interests
68
Q

COCP

MoA
Advantages
Disadvantages

A

MoA
Inhibits ovulation
Thickens cervical mucus
Thins endometrium

Advantages 
Reversible 
Reduced risk of 
endometrial ca
ovarial ca
colon ca
Reduces menorrhagia/ dysmenorrhoea 
Reduces acne

Disadvantages
Risk of
VTE
Breast cancer

Oestrogen effects - breast tenderness, headaches

Not protective against STIs
Drug interactions - AED, Abx
Not effective after D+V

69
Q

COCP major drug interactions

A

AED

some abx

70
Q

POCP

MoA
Advantages
Disadvantages

A

MoA
Thickens cervical mucus
Thins endometrium
Decreased tubular motility –> ectopic!

Advantages
No oestrogen effects eg breast tenderness
reversible
Can use in difficult population - Age, BMI, migraine HTN

Disadvantages 
Risk of ectopic 
Risk of ovarian cysts 
not protective against STIs
Can have irregular bleeding
71
Q

Implant

MoA
Advantages
Disadvantages

A

MoA
Inhibits ovulation
(+thickens C mucus)

Advantages
Can –> amenorrhoea
Reversible
Long acting

Disadvantages
Irregular bleeding
minor procedure
no STI protection

72
Q

Depo

MoA
Advantages
Disadvantages

A

MoA
Inhibits ovulation

Advantages
long acting
can cause amenorrhoea

Disadvantages 
Bone density 
weight gain 
Amenorrhoea for --> 12m after stopping 
Not immediately reversible 
injection
73
Q

Copper coil

MoA
Advantages
Disadvantages

A

MoA
Spermicide - decrease sperm motility

Advantages
Non hormonal
Long acting
Immediate affect - can be emergency contraception

Disadvantages 
Risk of menorrhagia and dysmenorrhoea 
Risk of perforation/ expulsion 
Risk of PID in first 20 days 
Risk of ectopic
74
Q

Mirena coil

MoA
Advantages
Disadvantages

A

MoA
thickens cervical mucus etc

Advantages
Reversible
Long acting
Can cause cessation of periods / reduce dysmenorrhoea/menorrhagia

Disadvantages
Irregular bleeding
^ risk PID (20), expulsion, perforation

75
Q

Diaphragm/ cap

MoA
Advantages
Disadvantages

A

MoA
Barrier + can contain spermicide

Advantages
Barrier - protect against STI
Non hormonal

Disadvantages
Need to leave in 6 hrs
Can be dislodged
Have to put in before sex

76
Q

Contraceptives time until effective

A

IUD - immediate

POCP - 2 days

All others - 7 days

77
Q

Emergency contraceptions

A

All need within 72 hrs
Ellaone
Levonelle
Progesterone

IUD - 5 days after or 5 days after likely ovulation date

78
Q

Contraception and breast feeding

A

COCP - NO <6w - cat2 if <6m

all others yes

IUD obvs least worry as no hormones

79
Q

When do women require contraception post partum

A

21 days

80
Q

Permanent female steralisation

A

Hysterectomy
Essure - coil - not reversible
Tubal ligation - not reversible on NHS

81
Q

Menopause

Management

(not risks and benefits)

A

1) Lifestyle
Sleep hygiene, meditation

2) HRT
Uterus? - O + P
No uterus? - Oestrogen

3) Non HRT
Rx symptoms
Eg vaginal dryness with creams/ topical oestrogen
Rx depression - SSRI

82
Q

Risks and benefits of menopause management

A

Benefits
Reduces symptoms
Reduces risk of long term things like osteoporosis

Risks 
- ^CV 
- Breast 
- VTE 
Others, Gall bladder disease,

Oestrogen specific
endometriosis
ovarian

83
Q

Premature menopause

Definition
Aetiology
Investigations
Management

A

definition <40

Aetiology

  • Idiopathic
  • Chromosomal
  • Iatrogenic
  • Infection
  • Autoimmune

Investigations
FSH >25 + 4 months amenorrhoea

Management
COCP/mirena

84
Q

Causes of amenorrhoea

A

Hypothalamus
Stress, anorexia, exercise, Kallmanns
FSH + LH are LOW

Anterior pituitary
Prolactinoma - ^prolactin

Thyroid - TSH ^ T4 low

Adrenals
CAH - ^testosterone
Tumour - CT
Cushings OGTT

Ovaries 
PCOS - ^testosterone, LH/FSH ratio ^
Androgen insensitivity syndrome 
POF 
Turners 
Uterus - USS/MRI 
Uterine abnormalities 
Imperforate hymen 
Transverse vaginal septum
Ashermans
85
Q

PCOS

Aetiology 
Presentation 
Investigations 
Management 
Complications
A

Aetiology
- Unknown - may be due to underlying insulin resistance
Insulin resistance + cysts –> ^ free floating androgens

Presentation 
TRIAD 
- Multiple cysts on USS 
- Androgen excess eg acne/hirsutism 
- Irregular periods

Other

  • Acanthosis nigricans
  • Subfertility
  • Weight gain
  • Insulin resistance

Investigations
LH/FSH ratio ^^^
Testosterone ^
USS - cysts

Others

  • ^ prolactin
  • Insulin ^
Management 
Non conceiving 
Rx hirsutism + acne 
COCP 
Spironolactone/ finasteride, eflornithine 
Conceiving help
Clomifene 
Metformin (combination or alone) 
GnRH 
IVF
86
Q

Kallman syndrome

A

Where hormone secreting neurones do not migrate to anterior pituitary

X linked

Anosmia
Amenorrhoea

Micropenis
Undescended testis

Low FSH and LH

Management - HRT

87
Q

Androgen insensitivity syndrome

A

X linked

There is resistance to testosterone

Amenorrhoea
Normal pubic hair
Undescended testis
Absence of uterus/vagina

Investigations
Buccal smear

Management
Remove testis (as ^ risk T cancer)
HRT

88
Q

Male sub fertility

Aetiology

A

Drugs - SSRI, steroids, smoking, chemo, BB
ED dysfunction - diabetes, neuro
CF
Decreased sperm count/ motility/ morphology
Hypospadias
hyperprolactinaemia
Klienfelters

Varicocoele
hydrocele

retrograde ejaculation
Autoimmune disease

Infection - gonorrhoea etc

89
Q

Male infertility

Investigations

A

USS
Urology
Vasogram

90
Q

Female subfertility

Aetiology

A

See amenorrhoea

Pelvic
Adheisons
Infections

91
Q

IVF process

A

Egg stimulation
GnRH agonist
then FSH everyday until folic 18-20mm then hCG administration (this causes OHSS)

Egg collection
Sperm collection
Culture
Embryo transfer

92
Q

OHSS

A

more follicles –> more oestrogen –> increased vascular permeability

Presentation 
Vascular compartment 
- Thrombosis 
- Hypotension --> shock 
- Hypoalbuminaemia - oliguria 
Tissue compartment
- ascites 
- hydrothorax 
- ovarian cysts 
- weight gain
93
Q

FGM stage

A

1) Partial/total removal of clitoris
2) Excision: partial/total removal of clitoris + labia minora +/- majora
3) Infibulation – narrowing of the vagina without excision of clitoris
4) Any other harmful procedure, piercing, incising, scraping

94
Q

Endometrial cancer histology

A

adenocarcinoma

95
Q

Rx endometriosis

A

Abolish cyclicity
- COCP/ mirena/progesterones,

GnRH
Ablation/ SO
Hysterectomy

96
Q

CIN histology

A

squamous

97
Q

PID Rx

A

Ofloxacin and metronidazole

IM Cef, oral doxy and oral metronidazole if suspect gonorrhoea

98
Q

When can IUD be used as emergency contraceptive (window)

A

IUD - 5 days after or 5 days after likely ovulation date

99
Q

Aetiology of polyhydramnios

A 
Idiopathic 
Foetal anomaly 
Multiple pregnancy
Maternal – diabetes/ renal
Oesophageal atresia
100
Q

Maternal complications of polyhydramnios

A

HTN

Dyspnoea

101
Q

Post party depression screening test

A

Edinburgh screening

102
Q

post natal depression RF

A 
Low SE status 
Smoking
Single mum 
domestic violence 
Neonatal illness
Multiple pregnancy
103
Q

Post natal depression protective factors

A

Financial status
Family
Breastfeeding

3a (6 decks)

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