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Obs + Gynae > Gynae > Flashcards

Gynae Flashcards

1
Q

How can bicornuate and unicornuate uterus be diagnosed?

A

Hysterosalpingogram

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2
Q

How can imperforate hymen present?

A

Primary amenorrhoea

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3
Q

How can imperforate hymen be relieved?

A

Cruciate incision

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4
Q

Describe the ovaries in Turner’s:

A

Thin, rudimentary ‘streak’ ovaries

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5
Q

What is FGM?

A

Removal or partial removal of external female genitalia, or injury to internal genital organs, for cultural or non-therapeutic reasons

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6
Q

If you see a patient under 18 with FGM, what should you do?

A

Report the case to the police

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7
Q

In the classification of FGM, what is type I?

A

Clitoridectomy

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8
Q

In the classification of FGM, what is type II?

A

Partial or total removal of clitoris and labia minora +/- labia majora

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9
Q

In the classification of FGM, what is type III?

A

Narrowing of vaginal orifice, apportioning of labia minora and/or labia majora +/- excision of clitoris

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10
Q

In the classification of FGM, what is type IV?

A

Any other harmful procedure to female genitalia

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11
Q

What are some acute complications of FGM?

A

Death, blood loss, sepsis, pain, urinary retention, blood borne viruses

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12
Q

What are some long term sequelae of FGM?

A

Apareunia, dyspareunia, sexual dysfunction, scarring, chronic pain, infections

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13
Q

What is a surgical management of FGM?

A

Defibulation - surgical opening of labia

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14
Q

What is primary amenorrhoea?

A

Failure to commence menses

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15
Q

What is secondary amenorrhoea?

A

Cessation of periods for >6m other than due to pregnancy

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16
Q

What is oligomenorrhoea?

A

Infrequent and irregular periods. >35d between cycles and <9 periods a year

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17
Q

What are some causes of amenorrhoea?

A 
Eating disorders
Prolactinoma 
PCOS
Turner’s
Asherman’s
Congenital adrenal hyperplasia
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18
Q

What tests may be performed to investigate amenorrhoea?

A 
bHCG 
FSH, LH, oestradiol, progesterone, testosterone 
Serum free androgen index
Prolactin
TFTs
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19
Q

What is dysmenorrhea?

A

Painful periods - cramps lower abdo pain

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20
Q

What is the management of dysmenorrhea?

A

Mefenamic acid during menstruation

Combined pill/Mirena coil

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21
Q

What is the Rotterdam criteria for diagnosis of PCOS?

A

Polycystic ovaries (12+)
Oligomenorrhoea/amenorrhoea
Hyperandrogenism

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22
Q

What are some other features of PCOS (not core 3)?

A 
Obesity 
Acne
Acanthosis nigricans 
Chronic pelvic pain
Depression
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23
Q

What is the management of PCOS?

A 
Weight loss, exercise, smoking cessation 
Metformin
Clomifene
COCP
Anti-androgen
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24
Q

What is menorrhagia?

A

Excessive menstrual loss that interferes with QoL

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25
Q

What are some causes of menorrhagia?

A 
Polyps 
Adenomyosis 
Fibroids
Malignancy
Coagulopathy
Dysfunctional uterine bleeding
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26
Q

What investigations should be considered in a pt presenting with menorrhagia?

A 
FBC
Haematinics
TFTs
Smear
STI screen 
Coag screen
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27
Q

What investigations should be considered in a pt aged >45y presenting with menorrhagia?

A

TVUS
Pipelle endometrial biopsy
Hysteroscopy + biopsy

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28
Q

What are some medical management options for menorrhagia?

A

Mirena IUS
Tranexamic acid
Mefenamic acid
COCP

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29
Q

What are some surgical management options for menorrhagia?

A

Endometrial ablation
Fibroids - myomectomy or uterine artery embolisation
Hysterectomy

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30
Q

What are some symptoms of the menopause?

A 
Menstrual irregularity 
Sweats
Palpitations
Flushes
Vaginal dryness 
Atrophy of breasts and genitalia
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31
Q

What HRT should be given to someone with a uterus?

And why?

A

Combined HRT

Unopposed oestrogen is rf for endometrial Ca

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32
Q

What are some contraindications to use of HRT?

A

Oestrogen dependent cancer
Past PE
Undiagnosed PV bleed
Raised LFTs

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33
Q

What are some side effects of HRT?

A 
Fluid retention 
Bloating 
Breast tenderness 
Nausea
Headaches
Leg cramps
Mood swings
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34
Q

What are some risks of HRT?

A

Increased risk of breast Ca
Unopposed oestrogen increases risk of endometrial CA
VTE risk
Gallbladder disease

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35
Q

What is the medical method of termination of pregnancy?

A

Mifepristone followed by misoprostol

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36
Q

What are the surgical methods of TOP?

A

Suction (7-14w)

Dilatation and evacuation (13-24w)

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37
Q

What are some complications of TOP?

A 
Failed TOP
Infection
Haemorrhage
Uterine perforation 
Cervical trauma 
Retained POC
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38
Q

What is a miscarriage?

A

Loss of pregnancy before 24w gestation

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39
Q

What is a threatened miscarriage?

A

Bleeding and/or pain with closed cervical os

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40
Q

What is an inevitable miscarriage?

A

Severe symptoms with open cervical os

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41
Q

What is an incomplete miscarriage?

A

Some POC passed and os open. Echogenic mass within uterine cavity >20mm in AP diameter

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42
Q

What is a complete miscarriage?

A

All POC passed. Bleeding and pain reducing, cervix closed

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43
Q

What is a missed miscarriage?

A

Foetus dies but remains in utero, cervix closed

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44
Q

How can a missed miscarriage be confirmed?

A

US: fetal pole >7mm with no fetal heart activity OR mean gestation sac diameter >25mm with no fetal pole or yolk sac

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45
Q

What are some maternal risk factors for miscarriage?

A

Increasing age, previous miscarriage, smoking, alcohol, diabetes, HTN

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46
Q

What is the expectant management for miscarriage?

A

Wait for POC to pass for 2 weeks

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47
Q

What is the medical management of miscarriage?

A

Misoprostol (oral or PV)

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48
Q

What is the surgical management of miscarriage?

A

Suction evacuation (usually under GA)

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49
Q

What is the definition of recurrent miscarriage?

A

Loss of 3 or more consecutive pregnancies with same partner

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50
Q

What are some causes of recurrent miscarriage?

A 
Infection
Parental chromosomal abnormality (balanced reciprocal or Robertsonian translocation)
Uterine abormality 
Antiphospholipid syndrome 
Thrombophilia
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51
Q

What prophylaxis should be given to a woman with antiphospholipid syndrome that has a positive pregnancy test?

A

Daily aspirin and LMWH

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52
Q

What is an ectopic pregnancy?

A

When the fertilised ovum implants outside of the uterine cavity

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53
Q

What factors can predispose to an ectopic?

A 
Damage to tubes (PID, previous surgery)
Previous ectopic 
Endometriosis 
IUCD, POP
Smoking 
IVF
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54
Q

What is the most common location for an ectopic?

A

Ampulla

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55
Q

Where is the most dangerous location for an ectopic?

A

Isthmus

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56
Q

What are some possible presentations for an ectopic pregnancy?

A 
Amenorrhoea
Pain (unilateral, iliac fossa)
PV bleed
Dizziness
Shoulder tip pain
D+V
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57
Q

What investigations should be performed if an ectopic is suspected?

A 
FBC
G+S
bHCG
Serum progesterone 
TVS
Speculum
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58
Q

What are the management options for an ectopic pregnancy?

A

Expectant
Methotrexate
Laparoscopic surgery or laparotomy

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59
Q

What are the surgical options for an ectopic pregnancy?

A

Salpingectomy if contralateral tube is healthy

Salpingotomy if not

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60
Q

What is the definition for a pregnancy of unknown location?

A

No sign of intrauterine or ectopic pregnancy or retained POC in presence of a positive pregnancy test

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61
Q

What are some outcomes for a pregnancy of unknown location?

A 
Early intrauterine pregnancy 
Complete miscarriage 
Failing PUL
Ectopic 
Persistent PUL
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62
Q

What are the differences between partial and complete moles?

A

Partial are triploid, complete diploid

Partial are more common, grow slower, present later and less often malignant

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63
Q

What are some features of molar pregnancy?

A 
Early pregnancy failure
Heavy bleeding
Abdo pain
Severe morning sickness
Uterus large for dates
Hyperthyroidism
64
Q

What are some investigations to be performed in suspected molar pregnancy?

A

bHCG
US
Histology of POC
If mets: MRI and CT

65
Q

What is the management of molar pregnancy?

A

Removal of molar tissue by suction curettage

66
Q

What are some features of choriocarcinoma?

A

Malaise
Uterine bleeding
Features of mets (lung)

67
Q

What is the management of choriocarcinoma?

A

Combination chemo based on methotrexate

68
Q

How does lichen sclerosis present?

A

White, flat, shiny skin in hourglass around vulva and anus
Intensely itchy
May be fissures or erosions

69
Q

What is the management for lichen sclerosis?

A

Clobetasol propionate cream

70
Q

What are some causes of VIN?

A

HPV 16, 18, 33

71
Q

What can be used to assist in visualisation of VIN?

A

5% acetic acid

72
Q

What are some management options for VIN?

A

Surveillance
Surgical removal
5% imiquimod cream

73
Q

What is a Bartholin’s cyst?

A

Blockage of ducts in Bartholin’s glands under labia minora

74
Q

What is the treatment for an abscess in Bartholin’s gland?

A

Incision and permanent drainage by marsupialisation or balloon catheter insertion

75
Q

What are some management options for vulval herpes simplex?

A

Analgesia
Lidocaine gel
Salt baths
Oral aciclovir if recurrent

76
Q

What are some ways in which vulval carcinoma may present?

A

Lump
Indurated ulcer with itching
Inguinal LN involvement

77
Q

What is the cause of cervical ectropion?

A

Endocervical epithelium extends into ectocervix and is prone to bleeding, excess mucus production and infection

78
Q

What can cause temporary ectropion extension?

A

Hormonal influence during puberty, pregnancy, COCP

79
Q

What are some management options for symptomatic cervical ectropion?

A

Stop COCP

Cautery with diathermy

80
Q

What are cervical polyps associated with?

A

Endometrial polyps

81
Q

What are the management options for cervical polyps?

A

Polypectomy - avulsion by twisting

Diathermy loop excision

82
Q

What ages are women eligible for the cervical screening programme?

A

25-64

83
Q

How often do women get cervical smears?

A

3 yearly between 25 and 50

5 yearly until 64

84
Q

How often should HIV +ve women have cervical smears?

A

Annually

85
Q

If a women’s smear shows borderline or mild dyskaryosis, what should be the next step?

A

Test for high risk HPV. If positive, refer for colposcopy

86
Q

If a women’s smear shows moderate or severe dyskaryosis, what should be the next step?

A

Refer for colposcopy (2WW)

87
Q

Describe the staging of CIN:

A

I - affects lower basal third of cervical epithelium
II - affects <2/3rds
III - affects >2/3rds or full thickness of epithelium

88
Q

What are some risk factors for cervical cancer?

A 
Persistent high risk HPV infection 
Smoking 
Multiple partners
Immunocompromise
High parity
89
Q

What is the management for CIN I?

A

Usually regresses

If HPV +ve offer 6 monthly colposcopy and LLETZ if persistent

90
Q

What is the management for CIN II + III?

A

LLETZ

91
Q

What are some complications of LLETZ?

A 
Haemorrhage
Infection
Vasovagal symptoms
Cervical stenosis 
Cervical incompetence
92
Q

What are some features of cervical cancer?

A 
Abnormal smear
PCB
PMB
Watery vaginal discharge 
Weight loss
93
Q

Describe the staging of cervical cancer:

A

I - confined to cervix
II - extended to upper 2/3rds of vagina
III - lower 1/3rd vagina
IV - spread to bladder or rectum

94
Q

What are the management options for cervical cancer?

A

Hysterectomy (Wertheim’s)

Chemoradiotherapy

95
Q

What are some complications of hysterectomy?

A 
Bleeding
Infection
VTE
Ureteric fistula
Bladder dysfunction
96
Q

What are some complications of cervical radiotherapy?

A 
Acute bladder and bowel dysfunction
Mucositis
Bleeding
Ulceration
Fistula
Vaginal stenosis, shortening and dryness
97
Q

When is endometritis more common?

A

Barrier to ascending infection (vaginal pH and cervical mucus) is broken e.g. after miscarriage, TOP, birth, IUCD insertion or surgery

98
Q

How does endometritis present?

A

Lower abdo pain
Fever
Uterine tenderness on bimanual
Offensive vaginal discharge

99
Q

How should endometritis be treated?

A

Antibiotics e.g. cefalexin and metronidazole

100
Q

What are some risk factors for endometrial cancer?

A 
Obesity, T2DM, HTN (increased peripheral oestrogens)
Nulliparity
Anovulatory cycles, such as PCOS
Early menarche/late menopause
HNPCC (Lynch syndrome) 
Breast cancer
Oestrogen only HRT
101
Q

How does endometrial cancer commonly present?

A

PMB

102
Q

How is endometrial cancer diagnosed?

A

TVUS showing endometrial thickness >4mm, biopsy, hysteroscopy

103
Q

How is endometrial cancer staged?

A

I – in body of uterus only
II – in body and cervix
III – advancing beyond uterus but not beyond pelvis
IV – extending outside of pelvis (e.g. bowel and bladder)

104
Q

What is the management of endometrial cancer?

A

Total hysterectomy with bilateral salpingo-oophorectomy

Adjuvant radiotherapy

105
Q

What are fibroids?

A

Benign smooth muscle tumours of the uterus (leiomyomas)

106
Q

How may fibroids present?

A 
Incidental finding 
Menorrhagia 
Fertility problems
Pain
Mass
107
Q

What are some medical treatment options for fibroids?

A

Mirena
Tranexamic acid
Goserelin
Ullipristal acetate

108
Q

What are some surgical treatment options for fibroids?

A

Myomectomy
Uterine artery embolisation
Hysterectomy

109
Q

How may ovarian cysts present?

A 
Incidental finding 
Chronic cyclical pain 
Dyspareunia
Acute pain due to torsion, bleeding, rupture
PV bleed
Mass
110
Q

What are some risk factors for ovarian cancer?

A

Nulliparity
Early menarche/late menopause
BRCA1 and BRCA2 mutations
Lynch syndrome

111
Q

How many ovarian cancer present?

A 
Often vague, GI-like symptoms
Bloating
Unexplained weight loss, loss of appetite
Fatigue
Urinary frequency and urgency
Change in bowel habit
Abdo or pelvic pain
PV bleed
Pelvic mass
112
Q

What investigations may you perform on someone with suspected ovarian cancer?

A

FBC, U+Es, LFTs, CA125, CA19-9, TVS, US abdo, CXR, CT abdo/pelvis, MRI, cytology of ascites

113
Q

What is the FIGO staging for ovarian cancer?

A
  1. Limited to one or both ovaries
  2. Limited to pelvis
  3. Limited to abdomen including regional LNs
  4. Distant mets outside of abdomen
114
Q

What are some features of PID?

A 
Lower abdo pain
Deep dyspareunia
Vaginal discharge
IMB or PCB
Dysmenorrhoea
Dysuria
Cervical motion tenderness
115
Q

What investigations should be performed in suspected PID?

A

Endocervical swabs
Full STI screen
Urine dip
Pregnancy test

116
Q

What are some complications of PID?

A 
Tubo-ovarian abscess
Fitz-Hugh-Curtis syndrome 
Recurrent PID 
Ectopic
Subfertility
117
Q

How should PID be treated as an outpatient?

A

Ceftriaxone 1g IM/azithromycin 1g PO plus doxycycline 100mg for 14d and metronidazole 400mg for 14d

118
Q

How should PID be treated as an inpatient?

A

Ceftriaxone 2g IV plus doxycycline 100mg IV followed by doxycycline 100mg for 14d and metronidazole 400mg for 14d

119
Q

What is endometriosis?

A

Presence of endometriotic tissue outside of the uterus

120
Q

How can endometriosis present?

A 
Cyclical pain
Constant pain due to adhesions
Severe dysmenorrhoea
Deep dyspareunia
Dysuria or pain on defection
Subfertility
Asymptomatic
Fixed retroverted uterus
121
Q

What is the gold standard investigation for endometriosis

A

Laparoscopy with biopsy

122
Q

What management options are available for endometriosis?

A 
NSAIDs/paracetamol for pain
COCP 
Progestogens 
Mirena IUS
Goserelin in subfertility
123
Q

What is adenomyosis?

A

Presence of functional endometrial tissue within the myometrium

124
Q

What are some features of adenomyosis?

A 
Menorrhagia
Dysmenorrhoea
Deep dyspareunia
Irregular bleeding
Enlarged boggy uterus
125
Q

What management options are available for adneomyosis?

A

NSAIDs and analgesia
COCP, progestogens, GnRH agonists and aromatase
inhibitors
Hysterectomy

126
Q

What are some risk factors for prolapse?

A 
Prolonged labour
Trauma from delivery
Pelvic floor muscle weakness
Obesity
Chronic cough
Constipation
127
Q

Describe the grading for uterine prolapse:

A

First degree: lowest part descends halfway down vaginal axis to the introitus
Second degree: lowest part to level of introitus and through on straining
Third degree: lowest part extends through introitus and out of vagina
Procidentia: uterus outside of vagina

128
Q

What symptoms may a woman with a prolapse describe?

A 
Dragging sensation
Discomfort
Lump ‘coming down’
Dyspareunia
Backache
Incontinence
129
Q

What are some conservative management options for prolapse?

A

Lose weight
Stop smoking
Stop straining
Improve muscle tone

130
Q

What are some medical + surgical management options for prolapse?

A

Pessaries
Surgical repair
Hysterectomy

131
Q

What are some signs and symptoms of incontinence?

A 
Frequency 
Nocturia
Urgency
Voiding difficulties (hesitancy, straining, slow stream) Feeling of incomplete emptying
Dysuria
Recurrent UTI
132
Q

What is stress incontinence?

A

Involuntary leakage of urine on effort or exertion, or on sneezing or cough

133
Q

What are some causes of stress incontinence?

A 
Pregnancy
Menopause
Radiotherapy or surgery 
Chronic cough
Obesity
Prolapse
134
Q

What is the conservative management for stress incontinence?

A

Weight loss, smoking cessation, treatment for chronic cough or constipation
Pelvic floor exercises

135
Q

What are some surgical management options for stress incontinence?

A

Bulking agents

Tension free vaginal tape

136
Q

What is urge incontinence?

A

Involuntary leakage of urine with a strong desire to pass urine

137
Q

What is the conservative management for urge incontinence?

A

Avoid excessive fluid intake esp. caffeine

Bladder retraining

138
Q

What is the medical management for urge incontinence?

A

Anticholinergics e.g oxybutynin
Mirabegron
Botox

139
Q

What investigations can be done in primary care for subfertility?

A 
Chlamydia screening
FSH, LH
TSH, prolactin, testosterone and rubella
Mid-luteal progesterone 
Semen analysis
140
Q

What investigations can be done in secondary care for subfertility?

A

TVS

Hysterosalpingogram (HSG)

141
Q

What lifestyle changes can be made as part of the management of subfertility?

A 
Weight loss
Healthy diet
Stop smoking, reduce alcohol
Regular exercise
Regular intercourse (every 2-3 days)
142
Q

What some methods of inducing ovulation in those that suffering from subfertility?

A 
Weight loss or gain
Clomifene citrate 
Laparoscopic ovarian drilling (in PCOS) 
Gonadotropins
Metformin (in PCOS)
143
Q

What are some indications for IVF?

A

Tubal disease
Male factor subfertility
Endometriosis
Unexplained >2 years

144
Q

What are the values in normal semen analysis? (volume, concentration, progressive motility, total motility and normal forms)

A 
Volume >1.5ml
Concentration >15 x10^6/ml
Progressive motility >32%
Total motility >40%
Normal forms >4%
145
Q

What investigations can be performed for male subfertility?

A

Testicular volume
FSH, testosterone, LH
Karyotyping

146
Q

What are some management options for male subfertility?

A

Lifestyle, optimise medical conditions, multivitamin (zinc, selenium, vit C)
Intracytoplasmic sperm injection (into egg)

147
Q

What is the difference between a total and subtotal hysterectomy?

A

Subtotal, cervix is left

148
Q

What are the risks associated with a hysterectomy?

A 
Bleeding, infection
Injury to bladder, bowels, vessels or ureters
VTE
Early menopause
If vaginal, vaginal vault prolapse
149
Q

What are the risks associated with endometrial ablation?

A

Bleeding, infection, uterine perforation, failed procedure, haematometra

150
Q

What is the pathophysiology of ovarian hyperstimulation syndrome?

A

Complication of ovulation induction or superovulation
Ovarian enlargement and fluid shift to extravascular space leading to accumulation in peritoneal and pleural spaces and hypercoagulability

151
Q

How may an individual suffering from ovarian hyperstimulation syndrome present?

A

Abdo discomfort, N+V, abdo distension, dyspnoea

152
Q

What general considerations should be thought about in the management of ovarian hyperstimulation?

A

Fluid balance
VTE prophylaxis
Drainage of ascites and pleural effusions

153
Q

What is the calculation for risk malignancy index?

A

RMI = Ultrasound result x menopausal status x CA125

154
Q

How is the ultrasound result scored in RMI?

A

1 point for each of: multilocular cysts, solid areas, mets, ascites, bilateral lesions
U = 1 for 0-1
U= 3 for 2-5

155
Q

How is menopausal status scored in RMI?

A 
1 = pre-menopausal 
3 = post-menopausal
156
Q

What are the cut offs for RMI?

A

<200 is low risk of malignancy

>200 is high risk, refer to gynae/cancer centre for management

Obs + Gynae (4 decks)

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