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obs and gynae > gynae > Flashcards

gynae Flashcards

1
Q

menopause symptoms

A

due to falling oestrogen levels
menstrual irregularity
vasomotor disturbance - sweats, palpitations, flushes
osteoporosis
vaginal dryness from vagina atrophy - causing infection, UTIs, dyspareuria

if dont want HRT, can be given SSRI

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2
Q

HRT
benefits
risks

A

Benefits
Relief of menopause symptoms
Bone mineral density protection
Possibly prevent long term morbidity

Risks
Breast cancer
VTE - risk with oral HRT
Cardiovascular disease - only when started in women over 60
Stroke
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3
Q

HRT
uterus
no uterus

A

uterus - combined HRT (oestrogen and progesterone)

no uterus - oestrogen only

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4
Q

Premature Ovarian Insufficiency (POI)

A

Menopause <40 yrs
Natural or Iatrogenic
Majority of cases – idiopathic
Other Chromosome abnormalities, FSH receptor gene polymorphisms
Diagnosis FSH >25IU/l – 2 samples >4 weeks apart + 4 months of amenorrhoea

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5
Q

endometriosis what is it

A

endometriotic tissue outside the uterus
cause unknown
hormonally (oestrogen) driven

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6
Q

endometriosis cause theories

A

retrograde menstruation - leads to adherence, invasion and tissue growth
metaplasia of mesothelial cells

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7
Q

endometriosis presentation

A

cyclical pain - due to endometrial tissue responding to menstrual cycle
constant pain - due to adhesions from chronic inflammation
dysmenorrhoea
dyspareunia

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8
Q

endometriosis treatment

A

combined OCP, or progesterones, or mirena
GnRH agonists (goserelin) - down regulate the pituitary gland (less FSH/LH) have menopausal SE so add HRT
hysterectomy - last resort

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9
Q

adenomyosis
what is it
symptoms
treatment

A 
endometrial tissue in myometrium
Cyclic pain, Dysmenorrhoea, Dyspareunia 
Progesterone IUS (mirena), hysterectomy
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10
Q

fibroids
what are they
location

A 
oestrogen dependent benign smooth muscle tumours of the uterus
can be:
subserosal - visceral peritoneum
intramural
submucosal - under the endometrium
pedunculated
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11
Q

fibroids presentation

A

many asymptomatic
menorrhagia (+/- anaemia)
fertility problems - submucosal interfere with implantation (infertility / miscarriage)
pain - torsion from pedunculated fibroids
Dysmenorrhea

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12
Q

fibroids management

A

myomectomy - to preserve fertility
GnRH analogues to reduce size before surgery (goserelin)
will shrink and calcify at menopause, HRT may cause them to grow
Ulipristal acetate
may cause pregnancy problems - malpresentation
hysterectomy - only cure, for those who have completed their family

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13
Q

heavy menstrual bleeding definition

A

Menstrual blood loss that is subjectively considered to be excessive by the woman and interferes with her physical, emotional, social and material quality of life

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14
Q

Menorrhagia definition

A

Heavy Menstrual Bleeding that occurs at expected intervals of the menstrual cycle

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15
Q

Heavy Menstrual Bleeding causes

A 
Uterine fibroids (20-30%)
Uterine polyps (5-10%)
Adenomyosis (5%)

women >45 think endometrial carcinoma

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16
Q

menorrhagia investigations

A 
FBC
transvaginal US
bimanual vaginal exam and speculum            
Endometrial biopsy if >45yrs and:
IMB
Unresponsive to treatment
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17
Q

menorrhagia treatment

A 
mirena
Antifibrinolytics (Tranexamic acid) - Inhibits tissue plasminogen activator
NSAID - Mefenamic acid
endometrial abalation - completed family
reassurance
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18
Q

infertility - ovarian reserve testing hormones (3)

A

FSH, Antral Follicle Count (AFC), Antimullerian Hormone (AMH)

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19
Q

infertility
ovulating hormones
ovarian reserve testing
tubual patency investigations

A

LH and progesterone

Ovulation / ovarian function
Semen Quality
Tubal Patency (+ Uterus)

hysterosalpingogram
USS

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20
Q

infertility - semen quality

A

Count (>15m/ml)
Motility (>40%)
Morphology (>4%)
Total >39m

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21
Q

male infertility treatment

A

Mild - Intrauterine Insemination (IUI)
Moderate abnormality - IVF
Severe – Intracytoplasmic Sperm Injection (ICSI)

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22
Q

polycystic ovarian syndrome diagnosis

A

2/3 of:
hyperandrogenism
oligomenorrhoea
polycystic ovaries on US

causes increased insulin and LH levels hyperandrogenism (testosterone)

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23
Q

polycystic ovarian syndrome management

A

clomifene citrate or tamoxifen - Oestrogen receptor modulators, induces ovulation (increases FSH). risk of ovarian cancer and multiple pregnancies

weight loss/metformin - improves insulin sensitivity

laproscopic ovarian drilling to those non responsive to above

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24
Q

IVF risks

A

Multiple Pregnancy
Miscarriage
Ectopic

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25
Q

endometrial cancer pathology

A

andenocarcinomas of columnar endometrial gland cells

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26
Q

endometrial cancer staging

A

1 - body of uterus only
2 - body and cervix only
3 - advancing beyond the uterus but not the pelvis
4 - outside the pelvis

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27
Q

endometrial cancer treatment

A

total hysterectomy with bilateral salpingo-oophorectomy
Adjuvant radiotherpay
progesterone therapy

28
Q

cervical polyps definition and symptoms

A

benign tumours of endocervical epithelium

may cause increased mucus discharge and postcoital bleeding

29
Q

cervical cancer risk factors

A

High risk HPV (16, 18)
Early age intercourse (<16 years)
Multiple sexual partners
STDs

30
Q

persistent HPV associated with …

A

cervical intra-epithelial neoplasia which is pre invasive stage for cervical cancer

31
Q

cervical intra-epithelial neoplasia 1,2 and 3

teatment

A

CIN 1 - lower basal 1/3 of cervical epithelium
CIN 2 - 2/3
CIN 3 - >2/3
invasive basal cell carcinoma when crosses the basement membrane

treatment - large loop excision of the transformation zone (LLETZ)

32
Q

cervical cancer staging

A

1 - confined to the cervix a) microscopic b) macroscopic
2 - a) to upper 2/3 vagina b) if to parametria
3 - a) extended to lower 1/3 of vagina b) or pelvic wall
4 - a) spread to bladder or rectum b) distant organs

33
Q

cervical cancer symptoms

A 
vaginal bleeding (post-coital)
watery discharge
ureteric obstruction
34
Q

vulval cancer symptoms

A 
Vulval itching
Vulval soreness
Persistent ‘lump’
Bleeding
Pain on passing urine
35
Q

vulval cancer staging

A

I <2cm (79% 5 yr survival)
II >2cm (59% 5 yr survival)
III Adjacent organs / Unilateral Nodes (43% 5 yr survival)
IV Bilateral nodes / Distant mets

36
Q

lichen sclerosis presentation

can predispose to …

A

autoimmune
elastic tissue turns to collagen
intensely itchy
can be a predisposing cause of vulval cancer

37
Q

lichen sclerosis management

A

clobetasol propionate cream

38
Q

vulval cancer pathology

A

squamous cell carcinoma

39
Q

ovarian cancer presentation

A 
asymptomatic / vague
Bloating / ‘IBS’ like symptoms
Abdominal pain/discomfort
Change in bowel habit
Urinary frequency
Bowel obstruction
40
Q

ovarian cancer aetiology

A 
epithelial cell (carcinoma) e.g. Serous cystadenocarcinomas
Endometrioid carcinoma
41
Q

ovarian cancer
risk factors
protective factors

A 
nulliparity
early menarche / late menopause
ovarian cysts
BRCA 1 / 2 mutations
HNPCC (lynch syndrome)

pregnancy
COCP

42
Q

ovarian cancer
investigations
tumour marker

A 
FBC,UE,LFT
transvaginal US
CXR
CT abdo/pelvis
CA125
43
Q

suspected ovarian cancer risk of malignancy

RMI formula

A

risk of malignancy index RMI = US x M x CA125
US score - 1 less than one abnormal feature of cyst on USS, 3 more than one abnormal feature of cyst on USS
M - menopause status 1 pre 3 post

250+ = refer

44
Q

ovarian torsion presentation

A

venous return is occluded
severe lower abdominal pain and vomitting
pain improves after 24 hours as ovary starts to die
whirl pool sign on TV US

45
Q

pelvic inflammatory disease symptoms

A

lower abdominal pain - uni or bilateral / constant or intermittent
dyspareunia
vaginal discharge

46
Q

pelvic inflammatory disease
management
investigations

A

ceftriaxone and metronidazole and doxycycline
Inflammatory markers are raised
USS excludes abscess and ovarian cyst

47
Q

ashermans syndrome what is it
cause
complications

A

scar tissue in the womb
often a result if miscarriage
can cause infertility, amenorrhoea

48
Q

prolactinoma presentation

A

menstrual disturbance
amenorrhoea / oligomenorrhoea
raised prolactin causes hypogonadism, infertility

49
Q

menopause investigations

A

anti-Müllerian hormone

FSH

50
Q

FIGO staging of ovarian cancer

A

1 - limited to one or both ovaries
2- limited to pelvis
3 - limited to abdomen
4 - distant metastases outside abdominal cavity

51
Q

Amenorrhoea – Investigations

A 
Pregnancy test if appropriate 
FSH/LH levels 
Prolactin levels 
Total testosterone and sex-hormone binding globulin levels
karyotyping - possible turners syndrome
52
Q

Primary amenorrhoea
Secondary amenorrhoea
Oligomenorrheoa

definitions

A

Primary amenorrhoea: periods have not started by age of 16
Secondary amenorrhoea: periods stop for 6 months or more
Oligomenorrheoa: Infrequent periods (more than every 35 days for 6 months)

53
Q

Irregular Menstruation and Intermenstrual Bleeding investigations

A 
Assess effect of blood loss- FBC
TFT/clotting if clinically indicated
FSH/LH levels if menopause suspected
Cervical smear if required
US of uterine cavity
Women > 35
Younger if medical treatment failed
54
Q

fibroids investigations

A

Abdominal/bimanual pelvic examination
US (transvaginal and transabdominal)
Hysteroscopy/hysterosalpingogram
FBC

55
Q

cervical / intrauterine polyps
presentation
Diagnosis
Management

A

asymptomatic
Menorrhagia
IMB

US
Hysteroscopy

Resection with cutting diathermy or avulsion

56
Q

endometrial cancer risk factors

A

Exogenous oestrogen - Unopposed oestrogen therapy
Endogenous oestrogen excess - PCOS with prolonged amenorrhea, Late menopause
T2DM
HNPCC / lynch syndrome

57
Q

endometrial cancer symptoms and signs

A

Postmenopausal bleeding (most common)
Premenopausal patients - Irregular/IMB, Occasionally recent onset menorrhagia
Atrophic vaginitis may coexist

58
Q

endometrial cancer investigations

A

tranvaginal US
endometrial biopsy
MRI abdo/pelvis
CXR

59
Q

cervical Intraepithelial Neoplasia
Screening guidlines
investigations

A

All females from age 25 or first intercourse, whichever comes last
Repeat every 3 years until 49
From age 50-64
Every 5 years
From age 65
Only those not screened since 50 or have had abnormal tests

cervical smear
colposcopy

60
Q

cervical cancer pathology

A

squamous cell carcinoma (70%)

61
Q

polycystic ovarian syndrome presentation

A

Stereotypical patient
Obese, acne, excess body hair
Oligo- or amenorrhoea
Miscarriage

62
Q

endometriosis investigations

A

laparoscopy and biopsy - Only way to be certain
transvaginal USS to visualise chocolate cysts
MRI if adenomyosis is suspected

63
Q

prolapse management

A

Pessary

surgery

64
Q

common causes of pelvic pain

A
  • Pelvic inflammatory disease occuring after the insertion of IUCD (common complication of this) but PID is usually more bilateral than unilateral
  • Uterine perforation
  • Acute PID – due to STI infection
  • Ectopic pregnancy
65
Q

secondary amenorrhoea causes

A

hypothalamic-pituitary-ovarian causes - stress, exercise, weight loss
hyperprolactinaemia
ovarian causes - polycystic ovarian syndrome
uterine causes - pregnancy

66
Q

cervical cancer treatment

A

radical hysterectomy
+/- chemoradiotherapy

may be able to do local excision (fertility sparing)

67
Q

ovarian cyst features

A

multilocular cyst
solid areas
metastases
ascities

obs and gynae (4 decks)

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