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Finals > Gynae > Flashcards

Gynae Flashcards

1
Q

Define primary amenorrhoea

A

failure to start menses by 16

by 14 if no signs of puberty

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2
Q

Define secondary amenorrhoea

A

previous menses, then no menstruation for >6m

NOT pregnant

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3
Q

causes of primary amenorrhoea

A 
constitutional delay
GU malformation
hypothalamic failure (anorexia, Kallman's)
gonadal failure (Turners)
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4
Q

causes of secondary amenorrhoea

A 
premature ovarian failure
HPO axis failure 
hyperprolactinaemia
ovarian (PCOS, tumours, menopause)
iatrogenic (depot, implant)
obstruction
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5
Q

features of Kallman’s

A

delayed puberty, anosmia, primary amenorrhoea

hypogonadotrophic hypogonadism in men

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6
Q

mx of Kallman’s

A

hormone replacement

GnRH for fertility

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7
Q

ix in amenorrhoea

if secondary?

A

FSH/LH, hCG, prolactin, karyotype, TFT, USS

if secondary –> check day 21 progesterone, serum free androgens

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8
Q

in amenorrhoea, when are FSH/LH raised?

when are they low?

A

Raised - ovarian failure (premature menopause)

Low - hypothalamic (constitutional delay, weight loss, anorexia, hypothalamic/pituitary tumour)

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9
Q

what causes raised prolactin?

which drug lowers it?

A

stress, hypothyroid, prolcatinomas, drugs

bromocriptine (dopamine agonist)

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10
Q

what increases testosterone/

A

androgen secreting tumour
CAH
Cushings
slightly raised in PCOS

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11
Q

what is ashermans?

A

adhesions in endometrium eg post surgery

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12
Q

what is sheehans?

A

necrosis of pituitary gland after PPH

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13
Q

define premature ovarian failure?

A

cessation of menses for 1 year before the age of 40

can be preceded by irregular cycles

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14
Q

pres of premature ovarian failure

A

cessation of menses for 1y <40

hot flushes, night sweats, vaginal dryness/atrophy, sleep disturbanc

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15
Q

RFs for POF?

A

FH
chemo/radio
autoimmune disease

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16
Q

endometriosis?

A

presence of endometrial tissue outside of the uterus

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17
Q

pres of endometriosis?

A

cyclical pain
deep dyspareunia
menorrhagia

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18
Q

ix in endometriosis?

A 
r/o other causes
abdo/pelvic exam
triple swabs
TVUS
abdo USS
**LAPAROSCOPY = gold standard**
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19
Q

mx of endometriosis

A

NSAIDs (ibuprofen, pcm, mefenamic acid)
Suppress menstruation (COCP, IUS, implant)
Specialised (GnRH analogues)

+/- surgery (improves fertility)

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20
Q

mechanism of GnRH analogues?

A

LH agonist - initially stimulates pituitary glad to secrete gonadotrophins then rapidly inhibits due to down regulation

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21
Q

what is adenomyosis

A

invasion of myometrium by endometrial tissue

endometriosis into myometrium

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22
Q

define menorrhagia?

A

excessive, regular menstrual loss (>80ml and/or >7d)

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23
Q

what if no underlying cause of menorrhagia?

A

DUB

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24
Q

causes of menorrhagia

A

fibroids, endometriosis, polyps, malignancy

coag disorder, hypothyroid, DM

anticoag treatment, chemo

DUB

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25
Q

what are fibroids?

A

benign tumour –> leiomyoma

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26
Q

ix of fibroids?

A

bulky non tender uterus

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27
Q

mx of fibroids?

A

goserelin (GnRH agonist)

<3cm - IUS, transexamic acid, NSAID, COCP

> 3cm - trans-cervical resection of fibroids, myomectomy

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28
Q

pres of fibroids?

A

menorrhagia, peliv pain, dysmenorrhoea, LUTS, bowel

+/- infertility

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29
Q

red flag sx in menorrhagia?

A

PCB/IMB
dyspareunia
dysmenorrhoea
discharge

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30
Q

ovarian cysts usually rupture mid cycle.. pres?

ix?

mx?

A

acute abdo pain, PV bleed, N+V

r/o ectopic!!! hCG
FBC swaps.
USS +/- laparoscopy

analgesia
if unstable –> surgery

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31
Q

pres of ovarian torsion?

A

acute abdo pain (u/l) radiating to back/thigh/pelvis

N+V

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32
Q

ix in ovarian torsion?

A

always r/o ectopic!!

USS

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33
Q

mx of ovarian torsion

A

laparoscopy

analgesi

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34
Q

Ovarian Ca

most common?

A

epithelial

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35
Q

RFs for ovarian ca?

A

unopposed oestrogen exposure
BRCA
HNPCC

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36
Q

pres of ovarian ca

A

vague + non-specific –> usually presents late

abdo bloating, early satiety, anorexia, urinary sx, PV bleeding

37
Q

ix in ovarian ca

A

RMI = [Ca125 x USS x menopausal status]

CT

38
Q

mx of ovarian ca

A

MDT
chemo
oophorecetomy

39
Q

endometrial ca type?

A

adenocarcinoma

40
Q

RFs for endometrial ca

A

unopposed oestrogen

41
Q

pres of endometrial ca

A

PMB

watery discharge

42
Q

ix of endometrial ca

A

US
hysteroscopy + biopsy
CXR + MRI

43
Q

mx of endometrial ca

A

TAH+BSO

+/- radio

44
Q

cervical ca type

A

SCC

45
Q

cervical ca RFs

A

HPV 16, 18
early intercourse
STIs
smoking

46
Q

pres of cervical ca

A

vaginal discharge
PCB
dyspareunia

47
Q

ix in cervical ca

A

Smear screening from 25-50 every 3y, 50-65 every 5

48
Q

what smear results = refer to colposcopy

A

borderinle dyskariosis AND HPV +ve
moderate dyskariosis
severe dyskariosis

49
Q

mx of cervical ca

A

dysplasia –> LLETZ
surgery + chemo

if >1b –> chemoradio

50
Q

define subertility?
% conceive in 1st year?
% conceive in 2 years?

A

failure to conceive in 1y of regular unprotected sex
80%
90%

51
Q

causes of subfertility

A 
unexplained 
male (30%)
ovulatory (35)
tubular (20%)
uterine disorders (10%)
52
Q

pres of PCOS?

A

infertility, obesity, acne, hirstute oligomenorrhoea, alopecia

53
Q

criteria for PCOS

A

Rotterdam (2/3)

  • polycystic ovaries
  • oligo-ovulation
  • hyperandrogenism
54
Q

mx of PCOS?
if planning pregnancy?
if not?

A

weight control and exercise

planning for preg [clomifene, metformin, ovarian drilling]

not planning for pregnancy [co-cyprinidrol, COCP, metformin]

55
Q

causes of female infertility

ovarian
tubular
other

A 
PCOS 
pituitary tumours
Sheehans
hyperprolactinaemia 
POF

PID
ashermans
fibroids
endometriosis

chronic disease
thyroid
adrenal

56
Q

Causes of primary amenorrhoea when secondary sexual characteristics are present?

A

GU malformation [imperforate hymen, transverse vaginal septum, absent uterus]

androgen insensitivity syndrome

endocrine [thyroid, hyperprolactinaemia, cushings]

57
Q

Causes of primary amenorrhoea with absent secondary sexual characterisits?

A

ovarian failure [gonadal dysgenesis (46XO), POF, chemo, pelvic radiation]

hypothalamic dysfunction [chronic illness, eating disorders]

others [tumours, infection, Kallman’s]

58
Q

5a-reductase deficiency?

A

people are genetically male (46XY) but cannot convert testosterone -> dihydrotestosterone

genitalia appear ambiguous / female at birth –> can be classified as a ‘primary amenorrhoea’ as thought to be female

59
Q

pres of androgen secreting tumour?

A

virilisation

60
Q

cause of CAH

A

21-OH deficiency

inefficient cortisol synthesis -> adrenal hyperplasia -> increased ACTH -> increased progesterone + DHEA + testosterone

61
Q

pres of CAH?

3 severities

A

salt-wasting crisis in first month of life

virilising CAH - genital ambiguity

late onset -

62
Q

causes of POF?

A

idiopathic
chemo
autoimmune

63
Q

causes of primary spermatic failure

A

chemo, maldescent, absent testes

klinefelteres

varicoceles

64
Q

when do you carry out mid-luteal progesterone level?

A

investigation in infertility

7 days before onset of menses
Eg day 21 of a 28 day cycle

65
Q

mx for menorrhagia? (1,2,3)

A

1 - mirena
2 - tranexamic acid, mefanamic acid, NSAIDs, COC
3 - prostaglandins, GnRH

+/- surgical - endometrial ablation, embolisation, hysterectomy

66
Q

how to improve fertility in endometriosis?

A

ablation

67
Q

mx for endometriosis

A

NSAIDs, COC, progesterones
GnRH
IUS
ablation

68
Q

mx of fibroids

A

mirena, tranexamic acid
GnRH -> shrinks prior to surgery
surgery - myomectomy, ablation, hysterectomy, embolisation

69
Q

3 main types of ovarian cyst

A

1 - functional [follicular, corpus luteal, theca lutein]
2 - benign epithelial cyst
3 - malignant

70
Q

comps of ovarian cyst

A

torsion
rupture
haemorrhage

71
Q

meigs syndrome triad ?

A

benign fibroma, ascites, pleural effusion

72
Q

histological classifications of breast ca

A 
invasive ductal adenocarcinoma - 75%
invasive lobar adenocarcinoma - 15%
medullary carcinoma - 5%
Paget's disease of breast -  1-4%
papillary carcinoma - 1%
73
Q

pres of breast ca

A 
lump
skin tethering
nipple inversion
dilated veins
ulceration 
peau d'orange
74
Q

how to describe a breast lump

A

hardness
irregularity
focal nodularity
fixation to skin/muscle

75
Q

breast cancer receptors?

A

estrogen receptor

HER2

76
Q

hormonal therapy drugs?

ER+
HER2+

A

ER+ -> tamoxifen

HER2+ -> herceptin (trastuzumab)=monoclonal antibody

77
Q

tamoixfen se

A

anti-oestrogen in breast

BUT pro-oestrogen on uterus -> increased risk of endometrial ca

78
Q

ix in breast ca

A

examination
imaging [young-USS; old-mammogram]
biopsy [FNA / core needle]

79
Q

mx of breast ca

A

surgery
+/- radio
+/- chemo
+/- hormonal therapy

80
Q

ix in CAH

A

17a- hydroxyprogesterone

81
Q

what is oligomennorhea

A

periods occur every 35d to 6m

82
Q

common sites for endometriosis tissue

A

uterosacral ligaments
ovaries - chocolate cyst

+/- pouch of douglas, bladder, vagina, lungs

83
Q

when to use hysteosalpingogram?

A

tests for tubal infertility

84
Q

what is PID

A

infection of upper female genital tract

85
Q

cause of PID

A

ascending infection form endocervix eg STI

86
Q

RFs for PID

A

age < 25
prev STI
multiple partners

87
Q

pres of PID

A

lower abdo pain
deep dyspareunia
vaginal d/c

may be aSx and present with infertility

88
Q

PID ix

A

bloods
chlamydia NAAT
USS

89
Q

mx of PID

A

abx to cover all potential organisms –> ceftriaxone (gonorrhoea), azithromycin (chlamydia), doxycycline, metronidazole (BV)

Finals (20 decks)

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