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fourth year > gynae > Flashcards

gynae Flashcards

1
Q

fibroid tumours are benign tumours of the

A

smooth muscle

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2
Q

fibroids are sensitive to which hormone?

A

oestrogen

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3
Q

common presentation for a fibroid

A

menorrhagia, prolonged menstruation, abdominal pain, bloating, urinary/bowel symptoms, deep dyspareunia and reduced fertility.

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4
Q

the initial investigation for submucosal fibroid with menorrhagia should be

A

hysteroscopy

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5
Q

what imaging may be considered and why for fibroids?

A

US - larger fibroids

MRI - surgical options

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6
Q

for fibroids less than 3cms first line tx

A

mirena coil

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7
Q

alt. Tx for fibroids less than 3cms

A

symptomatic (NSAIDS + Tranexamic acid), COCP, cyclical oral progestogens

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8
Q

surgical options for fibroids that cause menorrhagia

A

endometrial ablation, resection and hysterectomy

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9
Q

surgical options for large fibroids include

A

uterine artery embolisation, myomectomy, hysterectomy

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10
Q

why may GnRH agonists be used for treatment of fibroids

A

reduce the size of the fibroids by inducing a menopausal state usually for prior to surgery

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11
Q

what diagnosis would you consider in a pregnant women with a history of fibroids presenting with severe abdominal pain and low grade fever

A

red degeneration of fibroids

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12
Q

red degeneration of fibroids refer to

A

ischaemia, infarction and necrosis of fibroids commonly larger than 5cm.

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13
Q

management of red degeneration of a fibroid includes

A

supportive; rest, fluid and analgesia.

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14
Q

hypogonadotropic hypogonadism refers to

A

deficiency of LH and FSH

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15
Q

hypergonadotropic hypogonadism refers too

A

lack of response by the gonads

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16
Q

causes of hypogonadotropic hypogonadism includes

A

hormonal (pituitary or endocrine), inflammation (pituitary, hypothalamus, chronic conditions), constitutional (diet, delay, exercise), or kallman syndrome

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17
Q

causes of hypergonadotropic hypogonadism

A

gonad damage, absence of gonads or turner syndrome

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18
Q

congenital adrenal hyperplasia is caused by

A

congenital deficiency of 21-hydroxylase enzyme resulting in underproduction of cortisol and aldosterone and overproduction of androgens from birth

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19
Q

genetic inheritance of congenital adrenal hyperplasia

A

autosomal recessive

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20
Q

symptoms acutely for congenital adrenal hyperplasia

A

electrolyte disturbances and hypoglycaemia

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21
Q

later typical features of congenital adrenal hyperplasia

A

tall for age, facial hair, absent periods, deep voice, early puberty

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22
Q

androgen insensitivity syndrome results in

A

female phenotype but absent uterus, female sex organs and the presence of internal testes

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23
Q

initial investigations for primary amenorrhoea

A

FBC, ferritin, U+E’s, Anti-TTG and Anti ENA for coeliac disease

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24
Q

hormonal blood tests for primary amenorrhoea

A

FSH, LH, Thyroid function tests, insulin like growth factor 1 for GH deficiency, prolactin and testosterone (PCOS)

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25
Q

use of imaging for primary amenorrhoea

A

X-ray of wrist for constitutional delay, pelvic US, MRI for kallman or pituitary pathology.

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26
Q

TX for primary amenorrhoea

A

replacement hormones, reduction in stress, weight gain, CBT and COCP

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27
Q

TX for kallman syndrome or hypogonadotrophic hypogonadism

A

pulsatile GnRH

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28
Q

secondary amenorrhoea is defined as

A

no menstruation for more than three months or 3-6 months if prior evidence of irregular periods

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29
Q

causes of secondary amenorrhoea

A 
Pregnancy 
Menopause 
Hormonal contraception
Hypothalamic or pituitary 
PCOS
Uterine pathology such as Asherman’s syndrome
Thyroid pathology
Hyperprolactinaemiq
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30
Q

treatment for hyperprolactinaemia

A

bromocriptine and cabergoline

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31
Q

assessment of secondary amenorrhoea

A

history and examination, hormonal blood tests and US (PCOS)

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32
Q

hormonal tests for secondary amenorrhoea

A

FSH, LH, prolactin, TSH, and testosterone

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33
Q

secondary amonerrhoea high FSH suggests

A

primary ovarian failure

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34
Q

secondary amonerrhoea high LH suggests

A

PCOS

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35
Q

when secondary amenorrhoea lasts for longer than 12 months women are at risk for

A

osteoporosis

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36
Q

Tx for physical symptoms of premenstrual cycle

A

spironolactone

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37
Q

cyclical breast pain treatment

A

danazole and tamoxifen

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38
Q

Tx for PMS

A

lifestyle changes, COCP, SSRI’s, CBT

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39
Q

with severe symptoms and failure of medical management for PMS consider

A

Hysterectomy and bilateral oophorectomy with HRT post-op

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40
Q

gynaecological history questions

A 
age of menarche
cycle length
intermenstrual and post coital bleeding
contraceptive history
sexual history
pregnancy/plans
cervical screening
migraines
PMH, drug history, smoking, alcohol
FH
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41
Q

with heavy menstrual bleeding what examinations should be carried out?

A

pelvic, speculum and bimanual with FBC

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42
Q

outpatient hysteroscopy should be arranged if

A

Suspected submucosal fibroids

Suspected endometrial pathology, such as endometrial hyperplasia or cancer

Persistent intermenstrual bleeding

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43
Q

pelvic and transvaginal US should be arranged if

A

Possible large fibroids (palpable pelvic mass)

Possible adenomyosis (associated pelvic pain or tenderness on examination)

Examination is difficult to interpret (e.g. obesity)

Hysteroscopy is declined

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44
Q

symptomatic relief outwith contraception for heavy menstrual bleeding consider

A

tranexamic acid and mefenamic acid

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45
Q

contraceptive options for heavy menstrual bleeding

A

mirena coil, combined COCP, cyclical oral progestogens

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46
Q

final options for heavy menstrual bleeding

A

endometrial ablation (balloon thermal) or hysterectomy

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47
Q

potential causes of endometriosis

A

retrograde menstruation, embryonic cells, lymphatic spread and metaplasia

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48
Q

endometriosis adhesions lead to which symptoms

A

chronic non-cyclical pain and reduced fertility possibly.

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49
Q

presentation of endometriosis

A

Cyclical abdominal or pelvic pain
Deep dyspareunia (pain on deep sexual intercourse)
Dysmenorrhoea (painful periods)
Infertility
Cyclical bleeding from other sites, such as haematuria

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50
Q

gold standard diagnosis for endometriosis

A

laparoscopic surgery with biopsy of lesions

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51
Q

Stage 1 endometriosis

A

small superficial lesion

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52
Q

stage 2 endometriosis

A

mild, but deeper lesions than stage 1

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53
Q

stage 3 endometriosis

A

deeper lesions with lesions on the ovaries and mild adhesions

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54
Q

stage 4 endometriosis

A

deep and large lesions affecting the ovaries with extensive adhesions

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55
Q

hormonal management of endometriosis

A

COCP, POP, depo-provera, implant, mirena coil, GnRH agonists

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56
Q

surgical management of endometriosis

A

laparoscopic surgery or hysterectomy with bilateral salpingo-oopherectomy

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57
Q

adenomyosis presents with

A

painful heavy periods and dyspareunia

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58
Q

1st line investigation for adenomyosis

A

transvaginal ultrasound

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59
Q

gold standard diagnostic method for adenomyosis is

A

histological examination after hysterectomy

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60
Q

alternatives for transvaginal US for adenomyosis

A

MRI and transabdominal US

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61
Q

Tx for adenomyosis that is painless but don’t want contraception

A

tranexamic acid

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62
Q

Tx for for adenomyosis that is painful but don’t want contraception

A

mefenamic acid + NSAIDS

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63
Q

management for adenomyosis

A

mirena coil, COCP, cyclical oral progestogens

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64
Q

specialists options for adenomyosis

A

GnRH analogues, endometrial ablation, uterine artery embolisation, and hysterectomy

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65
Q

premature ovarian insufficiency is characterised as

A

hypergonadotropic hypogonadism

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66
Q

hormone analysis of premature ovarian insufficiency shows

A

raised LH and FSH but low oestradiol levels

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67
Q

hormone analysis of menopause will show

A

low oestrogen and progesterone but high LH and FSH

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68
Q

after the last menstrual period how long should contraception should be continued

A

1 year over 50, 2 years under 50

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69
Q

acceptable forms of contraception for menopausal women

A 
Barrier methods
Mirena or copper coil
Progesterone only pill
Progesterone implant
Progesterone depot injection (under 45 years)
Sterilisation
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70
Q

two key side effects of depo injections

A

reduced bone mineral density and weight gain

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71
Q

symptom management of perimenopausal symptoms

A

HRT, clonidine, CBT, SSRI (citalopram or fluoxetine), testosterone, vaginal oestrogen, vaginal moisturisers

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72
Q

the rotterdam criteria is for

A

PCOS diagnosis and it requires all three criteria to be met for diagnosis

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73
Q

all three points for the rotterdam diagnosis of PCOS

A

oligoovulation or anovulation, hyperandrogenism, and polycystic ovaries on ulstrasound.

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74
Q

presentation of PCOS

A 
Oligomenorrhoea or amenorrhoea
Infertility
Obesity (in about 70% of patients with PCOS)
Hirsutism 
Acne
Hair loss in a male pattern
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75
Q

differentials for PCOS

A

Medications, such as phenytoin, ciclosporin, corticosteroids, testosterone and anabolic steroids
Ovarian or adrenal tumours that secrete androgens
Cushing’s syndrome
Congenital adrenal hyperplasia

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76
Q

how does insulin resistance relate to PCOS

A

increased insulin:

promotes androgen release

suppresses sex hormone binding globulin from the liver

halts development of follicles

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77
Q

hormonal investigations for PCOS

A 
Raised luteinising hormone
Raised LH to FSH ratio (high LH compared with FSH)
Raised testosterone
Raised insulin
Normal or raised oestrogen levels
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78
Q

US appearance of PCOS

A

string of pearls (12 or more) and ovarian volume of more than 10cm cubed.

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79
Q

general management of PCOS

A

Weight loss
Low glycaemic index, calorie-controlled diet
Exercise
Smoking cessation
Antihypertensive medications where required
Statins where indicated (QRISK >10%)

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80
Q

PCOS increases risk for which cancer?

A

endometrial

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81
Q

why does PCOS increase risk for endometrial cancer?

A

unopposed oestrogen due to anovulation resulting in reduced progesterone.

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82
Q

options for reducing risk of endometrial hyperplasia in PCOS includes

A

mirena coil, cyclical progestogens and COCP

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83
Q

use of metformin in PCOS is for

A

fertility

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84
Q

treatment for hirsutism in PCOS

A

spironolactone

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85
Q

management for Acne in PCOS

A

COCP, as well as oral tetracycline, topic antibiotics or topical azelaic acid.

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86
Q

presentation of ovarian cyst

A

Pelvic pain
Bloating
Fullness in the abdomen
A palpable pelvic mass

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87
Q

most common type of ovarian cyst is

A

follicular

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88
Q

appearance of a follicular cyst on US

A

thin walls with no internal structure

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89
Q

common cyst to appear in early pregnancy

A

corpues luteum cyst

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90
Q

ovarian cysts Serous Cystadenoma is

A

benign epithelial tumour

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91
Q

Dermoid Cysts / Germ Cell Tumours is

A

benign teratoma of germ cells

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92
Q

Sex Cord-Stromal Tumours

A

rare connective tissue tumour may be benign or malignant

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93
Q

features that hint at malignany

A 
Abdominal bloating
Reduce appetite
Early satiety 
Weight loss
Urinary symptoms
Pain
Ascites
Lymphadenopathy
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94
Q

risk factors for ovarian malignancy

A 
Age
Postmenopause
Increased number of ovulations
Obesity
Hormone replacement therapy
Smoking
Breastfeeding (protective)
Family history and BRCA1 and BRCA2 genes
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95
Q

ovarian cancer tumour marker

A

CA125

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96
Q

tumour markers for germ cell tumour

A 
Lactate dehydrogenase (LDH)
Alpha-fetoprotein (α-FP)
Human chorionic gonadotropin (HCG)
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97
Q

Meig’s syndrome is a triad of

A

Ovarian fibroma (a type of benign ovarian tumour)
Pleural effusion
Ascites

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98
Q

ovarian torsion is usually due to a mass larger

A

5cm

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99
Q

presentation of ovarian torsion

A

sudden onset severe unilateral pelvic pain +/- nausea and vomiting. localised tenderness and mass.

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100
Q

US appearance of ovarian torsion

A

whirlpool sign of free fluid.

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101
Q

definitive diagnosis of ovarian torsion is by

A

laparoscopic surgery

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102
Q

treatment of ovarian torsion is by

A

laparscopic surgery

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103
Q

women with a uterus and HRT require

A

endometrial protection with progesterone

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104
Q

women without a uterus and HRT require

A

oestrogen only HRT

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105
Q

women with periods and HRT require

A

cyclical progesterone with breakthrough bleeds

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106
Q

HRT - postmenopausal women with a uterus and 12 months without a bleed require

A

continuous combined HRT

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107
Q

use of clonidine for menopausal symptoms is for

A

vasomotor symptoms and hot flushes (Alpha 2-adrenergic receptor agonist)

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108
Q

long term use of HRT for over 60’s risks

A

endometrial, ovarian and breast cancer. VTE, stroke and coronary artery disease.

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109
Q

risk reduction of HRT cancers through

A

local progestogens

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110
Q

VTE risk of HRT reduced through

A

patches rather than pills for oestrogen

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111
Q

CI for HRT

A 
Undiagnosed abnormal bleeding
Endometrial hyperplasia or cancer
Breast cancer
Uncontrolled hypertension
Venous thromboembolism
Liver disease
Active angina or myocardial infarction
Pregnancy
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112
Q

mirena coil is licensed for how many years

A

four

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113
Q

C19 progestogens are derived from

A

testosterone

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114
Q

C21 progestogens are derived from

A

progesterone

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115
Q

when should oestrogen contraceptives or HRT be stopped for surgery

A

4 weeks prior

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116
Q

oestrogenic SE

A 
Nausea and bloating
Breast swelling
Breast tenderness
Headaches
Leg cramps
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117
Q

progetogenic SE

A 
Mood swings
Bloating
Fluid retention
Weight gain
Acne and greasy skin
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118
Q

Asherman’s syndrome refers to

A

uterine adhesions post trauma commonly pregnancy, infection or surgical.

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119
Q

Asherman’s syndrome presents with

A

Secondary amenorrhoea (absent periods)
Significantly lighter periods
Dysmenorrhoea (painful periods)

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120
Q

diagnosis and treatment of Asherman’s syndrome is by

A

hysteroscopy

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121
Q

cervical ectropion refers too

A

cervical erosion resulting in the extension of the columnar epithelium of the endocervix extending out to the ectocervix

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122
Q

presentation of cervical ectropion

A

younger women pregnant or on COCP either asymptomatic or with discharge, vaginal bleeding, dyspareunia and post coital bleeding.

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123
Q

presentation of cervical ectropion of speculum

A

demarcted border between redder velvety columnar epithelium and pale pink squamous epithelium

124
Q

management of cervical ectropion

A

asymptomatic - nothing

Trouble with bleeding - cauterisation.

125
Q

Nabothian cysts are

A

trapped mucous of the columnar epithelium by squamous epithelium. asymptomatic benign finding.

126
Q

rectoceles are caused by a defect in the

A

posterior vaginal wall

127
Q

cystoceles caused by defects in the

A

anterior vaginal wall

128
Q

risk factors for a prolapse

A

Multiple vaginal deliveries
Instrumental, prolonged or traumatic delivery
Advanced age and postmenopause status
Obesity
Chronic respiratory disease causing coughing
Chronic constipation causing straining

129
Q

presentation of prolapse

A

A feeling of “something coming down” in the vagina
A dragging or heavy sensation in the pelvis
Urinary symptoms, such as incontinence, urgency, frequency, weak stream and retention
Bowel symptoms, such as constipation, incontinence and urgency
Sexual dysfunction, such as pain, altered sensation and reduced enjoyment

130
Q

what speculum would you use for investigation of a prolapse

A

Sim’s speculum.

131
Q

grade classification of pelvic organ prolapse

A

POP Q grade

132
Q

POP Q grade 1

A

the lowest part is more than 1cm above the vaginal canal (introitus)

133
Q

POP Q grade 2

A

The lowest part is within 1cm of the introitus

134
Q

POP Q grade 3

A

The lowest part is more than 1cm below the introitus, but not fully descended

135
Q

POP Q grade 4

A

Full descent with eversion of the vagina

136
Q

A prolapse extending beyond the introitus (vaginal canal) can be referred to as .

A

uterine procidentia.

137
Q

management for a prolapse

A

Conservative management
Vaginal pessary
Surgery

138
Q

urge incontinence is caused by

A

overactivity of the detrusor muscle of the bladder

139
Q

stress incontinence is due to

A

weakness of the pelvic floor and sphincter muscles

140
Q

overflow incontinence occurs when

A

there is chronic urinary retention due to an outflow obstruction

141
Q

potential causes for overflow incontinence

A

anticholinergic medications, fibroids, pelvic tumours, neurological conditions, MS and diabetic neuropathy

142
Q

risk factors for urinary incontinence

A 
Increased age
Postmenopausal status
Increase BMI
Previous pregnancies and vaginal deliveries
Pelvic organ prolapse
Pelvic floor surgery
Neurological conditions, such as multiple sclerosis
Cognitive impairment and dementi
143
Q

modifiable lifestyle factors for incontinence

A

Caffeine consumption
Alcohol consumption
Medications
Body mass index (BMI

144
Q

how to assess severity of incontinence by asking about

A

Frequency of urination
Frequency of incontinence
Nighttime urination
Use of pads and changes of clothing

145
Q

the modified oxford grading system is for

A

strength of pelvic muscle contractions during a bimanual examination

146
Q

investigations for incontinence

A

bladder diary, urine dipstick testing, post-void residual bladder volume and urodynamic testing

147
Q

management of stress incontinence involves

A

pelvic floor exercises
duloxetine
surgery

148
Q

surgical management of stress incontinence involves

A

tension free vaginal tape (TVT), colposuspension, sling procedure, intramural urethral bulking.

149
Q

management of urge incontinence

A

bladder retraining, anticholinergic medication, mirabegron, invasive options

150
Q

anti cholinergics side effects

A

dry mouth, dry eyes, urinary retention, constipation and postural hypotension. Importantly they can also lead to a cognitive decline, memory problems and worsening of dementia,

151
Q

mirabegron is CI in

A

uncontrolled hypertension as may lead to a hypertensive crisis

152
Q

invasive options for overactive bladder

A

botox, percutaneous sacral nerve stimulation, augmentation cytoplasty and urinary diversion

153
Q

atrophic vaginitis arises due to

A

lack of oestrogen

154
Q

diagnostic consideration in a older women presenting with recurrent UTI’s, stress incontinence or pelvic organ prolapse

A

atrophic vaginitis

155
Q

symptoms of atrophic vaginitis

A

Itching
Dryness
Dyspareunia (discomfort or pain during sex)
Bleeding due to localised inflammation

156
Q

management of atrophic vaginitis

A

topical oestrogen

157
Q

name of the glands located either side of the posterior part of the vaginal opening

A

bartholin’s glands

158
Q

treatment of a bartholin’s cyst

A

good hygiene, analgesia and warm compress

159
Q

bartholin’s abscess treatment

A

swab, culture and antibiotics

160
Q

common cause of bartholin’s abscess

A

E. Coli

161
Q

surgical management of a bartholin’s abscess

A

word catheter or marsupialisation

162
Q

lichen sclerosus is a

A

chronic inflammatory skin condition resulting in porcelain white skin

163
Q

typical presentation of lichen sclerosus

A

45-60 years complaining of vulval itching and skin changes or may be asymptomatic

164
Q

koebner phenomenon refers too

A

made worse by friction

165
Q

management of lichen sclerosus

A

topical steroids long term

166
Q

the upper vagina, cervix, uterus and fallopian tubes develop from the

A

paramesonephric ducts (mullerian ducts)

167
Q

what hormone suppresses the growth of the paramesonephric ducts in men?

A

anti-mullerian hormone

168
Q

genetic transmission of androgen insensitivity syndrome

A

X-linked recessive

169
Q

sex chromosomes of someone with androgen insensitivity

A

XY, however absent response to testosterone and conversion of androgens to oestrogen results in a female phenotype.

170
Q

androgen insensitivity often presents in infancy with

A

inguinal hernias containing testes

171
Q

management of androgen insensitivity syndrome

A

bilateral orchidectomy, oestrogen therapy, vaginal dilators

172
Q

cervical cancers are commonly what type?

A

squamous cell carcinoma

173
Q

HPV strains responsible for cervical cancer is

A

type 16 and 18

174
Q

pathological mechanism of HPV causing cancer is

A

inhibits tumour suppressor genes

175
Q

other than sexual activity what are other risk factors for cervical cancer

A

family history, HIV, full term pregnancies, COCP >5yrs, smoking

176
Q

presentation of cervical cancer

A

asymptomatic, Abnormal vaginal bleeding
Vaginal discharge
Pelvic pain
Dyspareunia

177
Q

CIN is grading for

A

level of dysplasia in cervix

178
Q

CIN 1

A

mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment

179
Q

CIN 2

A

moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated

180
Q

CIN 3

A

severe dysplasia, very likely to progress to cancer if untreated

181
Q

what does dyskaryosis refer to

A

precancerous changes

182
Q

cervical screening regime

A

Every three years aged 25 – 49

Every five years aged 50 – 64

183
Q

HPV positive with normal cytology follow up

A

repeat the HPV test after 12 months

184
Q

in colposcopy Acetic acid causes

A

abnormal cells to appear white

185
Q

Schiller’s iodine test in colposcopy causes

A

normal cells to stain brown

186
Q

treatment for CIN

A

A large loop excision of the transformation zone (LLETZ) or cone biopsy

187
Q

risk of performing LLETZ A large loop excision of the transformation zone is

A

depth of tissue may increase risk of preterm labour

188
Q

management of stage 1b-2a cervical cancer

A

Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy

189
Q

management of stage 2b-4a of cervical cancer

A

Chemotherapy and radiotherapy

190
Q

management of stage 4b of cervical cancer

A

Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care

191
Q

strain of HPV responsible for genital warts is

A

strain 6 and 11

192
Q

majority of endometrial cancer is

A

adenocarcinoma

193
Q

endometrial cancer is an example of what type of dependent cancers

A

oestrogen

194
Q

endometrial hyperplasia may be treated with

A

intrauterine mirena coil or oral progestogens

195
Q

risk factors for endometrial cancer

A 
(unopposed oestrogen) 
Increased age
Earlier onset of menstruation
Late menopause
Oestrogen only hormone replacement therapy
No or fewer pregnancies
Obesity
Polycystic ovarian syndrome
Tamoxifen
type 2 diabetes 
hereditary nonpolyposis colorectal cancer (HNPCC)
196
Q

why is obesity a key risk factor for endometrial cancer

A

adipose tissue is a source of oestrogen.

also in post menopausal women aromatase in adipose converts androgens into oestrogen.

197
Q

protective factors against endometrial cancer include

A

Combined contraceptive pill
Mirena coil
Increased pregnancies
Cigarette smoking

198
Q

endometrial cancer may present with

A 
post menopausal bleeding
Postcoital bleeding
Intermenstrual bleeding
Unusually heavy menstrual bleeding
Abnormal vaginal discharge
Haematuria
Anaemia
Raised platelet count
199
Q

NICE recommends transvaginal ultrasound in women over 55 year with

A

unexplained vaginal discharge and visible haematuria

200
Q

3 key investigations for endometrial cancer are

A

transvaginal ultrasound, pipelle biopsy and hysteroscopy

201
Q

endometrial thickness less than how many mm is a negative predictor for endometrial cancer?

A

<4mm

202
Q

treatment for stage 1 and 2 endometrial cancer is

A

total abdominal hysterectomy with bilateral salpingo-oophorectomy

203
Q

how may progesterone be used in the treatment of endometrial cancer?

A

slow down progression

204
Q

protective factors against ovarian cancer

A

Combined contraceptive pill
Breastfeeding
Pregnancy

205
Q

how may an ovarian mass cause hip or groin pain?

A

pressing on the obturator nerve

206
Q

refer to a 2 week wait if a physical examination reveals (gynae red flags for ovarian cancer)

A 
Ascites
Pelvic mass (unless clearly due to fibroids)
Abdominal mass
207
Q

name of a metastatic tumour in the ovary is

A

krukenburg tumour

208
Q

histiological sign for a krukenberg tumour is

A

signet ring cells

209
Q

significant level of Ca125 is

A

> 35IU/mL

210
Q

risk for malignancy index for ovarian mass being malignant takes into accord

A

Menopausal status
Ultrasound findings
CA125 level

211
Q

further investigations for an ovarian mass may require

A

paracentesis, CT and histology

212
Q

additional tumour cell markers for a complex ovarian mass include

A

A-FP and HCG

213
Q

non malignant causes of a raised Ca-125

A 
Endometriosis
Fibroids
Adenomyosis
Pelvic infection
Liver disease
Pregnancy
214
Q

ovarian cancer management

A

MDT, surgery and chemo

215
Q

risk factors for vulval cancer

A

Lichen sclerusos

216
Q

vulval cancers are usually

A

squamous epithelium

217
Q

vulval cancer frequently affects the

A

labia majora

218
Q

staging and diagnosis of vulval cancer requires

A

biopsy, sentinel node biopsy and CT

219
Q

management of vulval cancer requires

A

wide local excision, groin lymph node dissection, chemo or RT

220
Q

bacterial vaginosis is an overgrowth of what type of bacteria?

A

anaerobic bacteria such as gardnerella vaginalis

221
Q

bacterial vaginosis is due to the loss of what bacteria and what is their role?

A

lactobacilli and due to the production of lactic acid that lowers vaginal PH

222
Q

what pH does anaerobic bacteria prefer the vagina to be like?

A

alkaline

223
Q

risk factors of bacterial vaginosis

A

Multiple sexual partners (although it is not sexually transmitted)
Excessive vaginal cleaning (douching, use of cleaning products and vaginal washes)
Recent antibiotics
Smoking
Copper coil

224
Q

presentation of bacterial vaginosis

A

fishy smelling watery grey or white discharge

225
Q

examination for BV?

A

speculum

226
Q

investigations for BV?

A

vaginal pH, charcoal swab with micropscopy

227
Q

BV appearance on microscopy

A

clue cells

228
Q

treatment for BV is

A

metronidazole

229
Q

why is metronidazole CI with alcohol

A

disulfram like reaction causes nausea, vomiting, flushes and even shock with angiodema

230
Q

complications of BV in pregnancy

A 
Miscarriage
Preterm delivery
Premature rupture of membranes
Chorioamnionitis
Low birth weight
Postpartum endometriti
231
Q

risk factors for vaginal candidiasis

A

Increased oestrogen (higher in pregnancy, lower pre-puberty and post-menopause)
Poorly controlled diabetes
Immunosuppression (e.g. using corticosteroids)
Broad-spectrum antibiotics

232
Q

presentation of vaginal candidiasis

A

Thick, white discharge that does not typically smell.

Vulval and vaginal itching, irritation or discomfort

233
Q

investigations for vaginal candiasis

A

PH, charcoal swab and microscopy

234
Q

treatment for vaginal candiadiasis

A

single dose of intravaginal clotrimazole cream (5g) or single dose of fluconazole (150mg)

235
Q

OTC for vaginal candiadiasis

A

canesten duo

236
Q

chlamydia trachomatis is what type of bacteria

A

gram negative intracellular organism

237
Q

charcoal swabs are for

A

microscopy and culture

238
Q

the transport medium for charcoal swabs are

A

Amies transport medium

239
Q

charcoal swabs can confirm

A

Bacterial vaginosis
Candidiasis
Gonorrhoeae (specifically endocervical swab)
Trichomonas vaginalis (specifically a swab from the posterior fornix)
Other bacteria, such as group B streptococcus (GBS)

240
Q

NAAT is used for

A

DNA or RNAA of chlamydia or gonorrhoea

241
Q

female presentation of chlamydia

A 
asymptomatic 
Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding (intermenstrual or postcoital)
Painful sex (dyspareunia)
Painful urination (dysuria)
242
Q

male presentation of chlamydia

A 
asymptomatic 
Urethral discharge or discomfort
Painful urination (dysuria)
Epididymo-orchitis
Reactive arthritis
243
Q

signs of chlamydia infection on examination

A 
Pelvic or abdominal tenderness
Cervical motion tenderness (cervical excitation)
Inflamed cervix (cervicitis)
Purulent discharge
244
Q

treatment for chlamydia includes

A

doxycycline 100mg twice a day for 7 days.

245
Q

is doxycycline CI in pregnancy

A

yes

246
Q

complications of chlamyida include

A 
Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Lymphogranuloma venereum
Reactive arthritis
247
Q

lymphogranuloma venereum refers too

A

lymphoid tissue around the site of infection with chlamydia

248
Q

primary stage of LGV

A

painless ulcer

249
Q

secondary stage of LGV

A

lymphadenitis

250
Q

tertiary stage of LGV

A

inflammation of the rectum, changes in bowel habit, tenesmus and discharge

251
Q

Tx for LGV

A

Doxycycline 100mg twice daily for 21 days

252
Q

presentation of chlamydial conjunctivitis

A

It presents with chronic erythema, irritation and discharge lasting more than two weeks. Most cases are unilateral.

253
Q

neisseria gonorrhoeaeis an example of

A

gram negative diplococcus bacteria

254
Q

pathology of gonorrhoea

A

STI that infects mucuous membranes with columnar epithelium

255
Q

female presentation of gonorrhoea

A

Odourless purulent discharge, possibly green or yellow
Dysuria
Pelvic pain

256
Q

male presentation of gonorrhoea

A

Odourless purulent discharge, possibly green or yellow
Dysuria
Testicular pain or swelling (epididymo-orchitis)

257
Q

investigation of gonorrhoea

A

NAAT through first catch urine or swab will determine presence

Charcoal swab will determine specificity and sensitivity

258
Q

tx of gonorrhoea

A

A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known
A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known

259
Q

test of cure for gonorrhoea should be conducted after

A

72 hours after treatment for culture
7 days after treatment for RNA NATT
14 days after treatment for DNA NATT

260
Q

complications of gonorrhoea

A 
Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Epididymo-orchitis (men)
gonococcal conjunctivitis in a neonate
and disseminated gonococcal infection
261
Q

disseminated gonococcal infection causes

A

Various non-specific skin lesions
Polyarthralgia (joint aches and pains)
Migratory polyarthritis (arthritis that moves between joints)
Tenosynovitis
Systemic symptoms such as fever and fatigue

262
Q

mycoplasma genitalium is a

A

bacteria that causes non-gonococcal urethritis

263
Q

investigations for mycoplasma genitalium

A

NAAT through vaginal swabs or first urine sample

264
Q

management of mycoplasma genitalium is

A

Doxycycline 100mg twice daily for 7 days then;

Azithromycin 1g stat then 500mg once a day for 2 days (unless it is known to be resistant to macrolides)

265
Q

pelvic inflammatory disease is a major cause of

A

tubular infertility and chronic pelvic pain

266
Q

PID may be caused by

A

Neisseria gonorrhoeae tends to produce more severe PID
Chlamydia trachomatis
Mycoplasma genitalium

267
Q

presentation of PID is

A 
Pelvic or lower abdominal pain
Abnormal vaginal discharge
Abnormal bleeding (intermenstrual or postcoital)
Pain during sex (dyspareunia)
Fever
Dysuria
268
Q

examination signs of PID involve

A

Pelvic tenderness
Cervical motion tenderness (cervical excitation)
Inflamed cervix (cervicitis)
Purulent discharge

269
Q

investigations for PID are

A

HIV test, NAAT swabs and syphilis test, pregnancy test, inflammatory markers and microscopy

270
Q

PID sign on microscopy are

A

pus cells

271
Q

complications of PID are

A 
Sepsis
Abscess
Infertility
Chronic pelvic pain
Ectopic pregnancy
Fitz-Hugh-Curtis syndrome
272
Q

fitz-hugh-curtis syndrome refers too

A

inflammation and infection of the liver capsule leading to adhesions

273
Q

fitz-hugh-curtis syndrome presents with

A

right upper quadrant pain, shoulder tip pain

274
Q

investigation of fitz-hugh-curtis syndrome

A

therapeutic laparoscopy

275
Q

trichomonas is classified as

A

a protozoan

276
Q

trichomonas increases risk of

A 
Contracting HIV by damaging the vaginal mucosa
Bacterial vaginosis
Cervical cancer
Pelvic inflammatory disease
Pregnancy-related complication
277
Q

symptoms of trichomonas are

A

Vaginal discharge (frothy and yellow-green with fishy smell)
Itching
Dysuria (painful urination)
Dyspareunia (painful sex)
Balanitis (inflammation to the glans penis)

278
Q

examination of the cervis with trichomonas reveals

A

a strawberry cervix

279
Q

trichomonas investigation is with

A

swab, first catch urine or charcoal swab

280
Q

management of trichomonas is with

A

metronidazole

281
Q

HSV-1 remains dormant in the

A

trigeminal nerve ganglion

282
Q

HSV-2 remains dormant in the

A

sacral nerve ganglia

283
Q

signs and symptoms of genital herpes are

A

episodic:

Ulcers or blistering lesions affecting the genital area
Neuropathic type pain (tingling, burning or shooting)
Flu-like symptoms (e.g. fatigue and headaches)
Dysuria (painful urination)
Inguinal lymphadenopathy

284
Q

diagnosis of genital herpes is through

A

viral PCR

285
Q

management of genital herpes is with

A

aciclovir, lidocaine and topical vaseline.

286
Q

the main issue with genital herpes during pregnancy is

A

neonatal herpes simplex infection

287
Q

after an initial infection later on during pregnancy the antibodies can

A

confer a passive immunity via the placenta

288
Q

primary infection before 28 weeks gestation with herpes is treated with

A

aciclovir

289
Q

primary genital herpes after 28 weeks gestation is treated with

A

aciclovir with a recommended cesarean section

290
Q

HIV is what type of virus

A

RNA retrovirus

291
Q

aid’s defining illnesses include

A 
Kaposi’s sarcoma
Pneumocystis jirovecii pneumonia (PCP)
Cytomegalovirus infection
Candidiasis (oesophageal or bronchial)
Lymphomas
Tuberculosis
292
Q

normal CD4 count is

A

500-1200

293
Q

end stage HIV is defined as

A

<200 CD4

294
Q

highly active anti retrovirus therapy medication examples

A

Protease inhibitors (PIs)
Integrase inhibitors (IIs)
Nucleoside reverse transcriptase inhibitors (NRTIs)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Entry inhibitors (EIs)

295
Q

what prophylaxis is given for CD4 <200 to protect against pneuocystis jirovecii pneumonia

A

co-trimoxazole

296
Q

HIV tests should be done

A

immediately and also three months after exposure.

297
Q

syphilis is caused by

A

treponema pallidum a spirochete.

298
Q

primary syphilis involves

A

painless ulcer called a chancre

299
Q

secondary syphilis involves

A

systemic symptoms

300
Q

latent syphilis refers too

A

asymptomatic infection

301
Q

tertiary syphilis involves

A

gummas, neurological and aortic aneurysms

302
Q

secondary syphilis symptoms

A 
Maculopapular rash
Condylomata lata (grey wart-like lesions around the genitals and anus)
Low-grade fever
Lymphadenopathy
Alopecia (localised hair loss)
Oral lesions
303
Q

neurosyphilis symptoms are

A 
Headache
Altered behaviour
Dementia
Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
Ocular syphilis (affecting the eyes)
Paralysis
Sensory impairment
304
Q

argyll-robertson pupil refers too

A

It is a constricted pupil that accommodates when focusing on a near object but does not react to light in neurosyphilis

305
Q

diagnosis of syphilis is through

A

antibody testing (RPR, VDRL), with dark field microscopy and PCR

306
Q

management of syphilis involves

A

A single deep intramuscular dose of benzathine benzylpenicillin

fourth year (12 decks)

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