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Obs and gynae > Gynae > Flashcards

Gynae Flashcards

1
Q

What are the 2 main types of incontinence and their symptoms?

A

stress - involuntary leakage due to sudden increase in intra-abdominal pressure with bladder neck slipped below pelvic floor
overactive/urge - urgency

(mixed, neurogenic)

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2
Q

How would you treat incontinence?

A

stress - physio, surgery

overactive - bladder drill, botox, bypass (catheters), drugs (atropine)

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3
Q

What are the tests for incontinence?

A 
FVC - frequency volume chart 
MSU - urinalysis 
RU - residual urine 
ePAQ - electronic personal assessment questionnaire
urodynamics
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4
Q

What is it?

Multiparous woman comes in with dysmenorrhea, heavy bleeding, dysparunia

A

Adenomyosis

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5
Q

What would you find on TVUS of adenomyosis?

A

large asymmetrical uterus, distorted myometrium, thickened junctional zone

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6
Q

What is it?
Nullparious, family history
Dysmenorrhea, dyschezia, dysparunia, fixed and tender retroverted uterus, cervical excitation, uterosacral ligament nodularity

A

Endometriosis

  • chronic cyclical pelvic pain
  • infertility
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7
Q

What would you use to diagnosis endometriosis?

A

Laparoscopy

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8
Q

What is it?

Bilateral lower abdo pain, deep dysparunia, abnormal bleeding, cervical motion tenderness, adnexal tenderness

A

PID - inflammation of upper genital tract

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9
Q

What is it?

Infertility, heavy periods, pelvic pain, irregular firm mass

A

Fibroids

  • benign neoplasm of smooth muscle in myometrium
  • menorrhagia + IMB, dysmenorrhoea, subfertility
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10
Q

What is the largest RF of fibroids?

A

High BMI

nearer menopause, afro-carribean

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11
Q

What is it?

Post-coital bleeding , HPV positive

A

Cervical cancer

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12
Q

How would you test for cervical cancer?

A

Colposcopy and biopsy

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13
Q

What is the most common type of cervical cancer?

A

90% squamous

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14
Q

What is it?

Obese, diabetic, nullparious patient, HRT, postmenopausal bleeding

A

Endometrial cancer

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15
Q

How would you test for endometrial cancer?

A

TVUS = endometrial thickness >4mm

Hysterscopy and endometrial biopsy

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16
Q

What is the most common type of endometrial cancer?

A

adenocarcinoma

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17
Q

What is it?

BRCA, early menarche, nulliparous, bloating, CIBH

A

Ovarian cancer

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18
Q

How would you test for ovarian cancer?

A

CA125 - high

TVUS - multiocular, solid, metastases, ascites, bilateral lesions

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19
Q

What is it?

Infertility, amenorrhoea, acne, hirsutism, deep voice, alopecia, acanthosis migricans, increased muscle mass

A

PCOS

-obese, acne, hirsutism, oligo/amenorrhoea, subfertility, miscarriage

20
Q

Which conditions are a risk in PCOS?

A

T2DM, acne, sleep apnoea, endometrial hyperplasia, hirturism, GDM

21
Q

What are the diagnostic criteria for PCOS?

A

Rotterdam criteria
2/3 of olgio/amennhorea, polycystic ovaries, and clinical/biochemical signs of hyperandrogenism
Tests - US

22
Q

What differentials of acute pelvic pain could you use an US to differentiate between?

A

Ectopic pregnancy, miscarriage, ovarian torsion, ovarian cyst rupture, appendicitis, subchorionic haemorrhage

23
Q

What on US would indicated malignant ovarian cyst?

A

multiocular, thickened walls, abnormal contents, projections

24
Q

What on US would indicate ovarian torsion?

A

increased ovarian size - oedema, impaired venous drainage

25
Q

What would you use to test for migrated IUD?

A

XR

26
Q

What can elevate CA125?

A

Ovarian cancer, ovarian cyst rupture, infection, menstruation, endometriosis, haemorrhage, peritonitis

27
Q

When would you do conservative management of ovarian cyst?

A

Simple cyst <10cm, normal CA125, postmenopausal

do serial US monitoring

28
Q

What on bimanual examination would indicate endometriosis?

A

cervical excitation, adnexal tenderness, uterine ligament abnormality

29
Q

How would you treat endometriosis?

A

Progesterone only - pill, coil, injection
COCP*
GnRH agonist (triptorclin) and HRT
mefenamic acid as pain relief
Trial exclusion diets of diary and wheat, exercise, psychological therapes
Ablation, excision of extrauterine endometrial tissue, oophorectomy, hysterectomy

30
Q

How do you treat stress incontinence?

A

lifestyle
pelvic floor muscle training
surgery
Duloxetine

31
Q

How do you treat urge incontinence?

A

conservative
bladder training - first line
anticholinergics (oxybutynin)

32
Q

What are the three types of prolapse?

A

Anterior wall - cystocele, urethrocele, cystourethrocele
Posterior wall - enterocele, rectocele
Apical - uterovaginal, vault

33
Q

What are risk factors of prolapse?

A

Weak pelvic floor

  • vaginal delivery and pregnancy
  • congenital - abnormal collagen metabolism
  • chronic predisposing factors
  • iatrogenic factors - e.g. pevlic surgery
34
Q

What are the symptoms of prolapse?

A

incontinence, heaviness, pain, dyspareunia, dragging sesnsation

35
Q

How do you prevent and treat prolapse?

A

Prevent - weight reduction, smoking, treat chronic triggers, pelvic floor exercises
Treat - Pessaries, estrodial cream, surgery (e.g. manchester repair, vaginal hysterectomy)

36
Q

How do you treat fibroids?

A

tranexamic acid, NSAIDs, progestogens, IUS, COCP
GnRH agonist
uterine artery embolization
hysteroscopic resection, open/laparoscopic myomectomy, hysterectomy/endometrial ablation

37
Q

What would the tests for PCOS show?

A

Elevated - LH, AMH, serum testosterone, insulin
Low - serum sex hormone binding globulin
TVUSS - polycystic ovaries

38
Q

How do you treat PCOS?

A

Conservative - lose weight, exercise, diet, smoking cessation
COCP, metformin
Anti-androgens - cyproterone acetate, spironolactone, vaniga facial cream
Fertility treatment

39
Q

What are some complications of PID?

A

ectopic pregnancy, infertility, tubo-ovarian abscess, adhesions

40
Q

How would you treat PID?

A

IM cefriaxone

PO doxycycline or metronidazole

41
Q

What are some causes of PCB?

A

Infection, cervical ectropion, cervical or endometrial polyps, vaginal or cervical cancer, trauma or sexual abuse, vaginal atrophic change

42
Q

What are some causes of IMB?

A

Pregnancy related (ectopic, GTB), pysiological, Vaginal causes (adenosis, vaginitis, tumours), cervical (infection, cancer, polyps, ectropian), uterine (fibroids, polyps, cancer, adenomyosis, endometriosis), missed pills, following smear

43
Q

How would you investigate PCB/IMB?

A

TVUS

smear test

44
Q

What is marsupialization?

A

surgical technique of cutting slit into cyst and suturing the edges

45
Q

What is Asherman’s syndrome?

A

scar tissue in uterus or on cervix

Obs and gynae (8 decks)

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