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PACES 2 > Gynae > Flashcards

Gynae Flashcards

1
Q

Investigations for abnormal uterine bleeding

A

Bedside

  • General examination looking for signs of anaemia and abdominal masses
  • Urine pregnancy test
  • Bimanual examination
  • Speculum

General

  • Observations:
    • BP
    • HR

Bloods

  • FBC – anaemia
  • U&Es – dehydration

Imaging:

  • TVUSS
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2
Q

Ddx for abnormal uterine bleeding

A
  • Dysfunctional uterine bleeding
  • Fibroids
  • Endometriosis
  • Endometrial cancer
  • Miscarriage
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3
Q

Mx of Fibroids/Endometriosis/DUB

A
  • Medical:
    • 1st line: LNG-IUS (if endometrial cavity not distorted)
    • Tranexamic acid + mefenamic acid if dysmenorrhoea
    • COCP or cyclical oral progestogens
    • Ferrous Sulphate
  • Surgical:
    • Myomectomy (+/- GnRH agonist)
    • Uterine artery embolization
    • Laparoscopic ablation in endometriosis
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4
Q

Differentials for postmenopausal bleeding

A
  • Endometrial cancer
  • Atrophic vaginitis
  • Cervical/vulval cancer
  • Cervical polyps
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5
Q

Investigations for postmenopausal bleeding

A
  • Abdominal examination looking for masses
  • Bimanual examination
  • Speculum
  • 2 week wait referral:
    • TVUSS
    • Hysteroscopy and biopsy
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6
Q

Management of endometrial cancer

A
  • Localised disease:
    • TAH +BSO
    • Progesterone therapy if unable to tolerate surgery
  • Severe disease:
    • Adjuvant radiotherapy
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7
Q

RF for endometrial cancer

A
  • Obesity
  • Nulliparity
  • Early menarche and late menopause
  • Unopposed oestrogen therapy
  • Diabetes mellitus
  • Tamoxifen
  • PCOS
  • HNPCC
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8
Q

Subtypes of endometrial cancer

A
  • Endometrioid
  • Mucinous
  • Secretory
  • Serous
  • Clear Cell
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9
Q

Figo staging of endometrial cancer

A
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10
Q

Differentials for chronic pelvic pain

A
  • Endometriosis
  • PID
  • Adenomyosis
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11
Q

Investigations for chronic pelvic pain

A
  • Bedside:
    • Abdominal examination
    • Bimanual looking for cervical excitation and adnexal tenderness
    • Speculum
    • High vaginal swabs
    • Endocervical swabs
    • Urine dipstick and MC&S
  • Bloods:
    • WCC
    • CRP
    • HIV serology
  • Imaging:
    • TVUSS
      • Adenomyosis – venetian blind appearance
    • MRI
      • Gold standard adenomyosis
  • Laparoscopic exploration - endometriosis
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12
Q

Endometriosis Management

A
  • Medical:
    • 1st line: LNG-IUS
    • Tranexamic acid + mefenamic acid if dysmenorrhoea
    • COCP or cyclical oral progestogens
    • Ferrous Sulphate
  • Surgical:
    • Laparoscopic ablation in endometriosis
    • Hysterectomy in adenomyosis
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13
Q

PID Management

A

PID management

  • Medical:
    • IM ceftriaxone 1g stat
      • 2 weeks PO doxycycline 100mg BD and metronidazole 400mg BD
  • Surgical:
    • USS guided drainage of abscess
    • Laparoscopic adhesiolysis
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14
Q

Complications of PID

A
  • Fitz-Hugh-Curtis syndrome
  • Ectopic pregnancy in future
  • Tubal infertility
  • Chronic pelvic pain
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15
Q

Investigations for discharge

A
  • Bedside:
    • Abdominal examination
    • Bimanual looking for cervical excitation and adnexal tenderness
    • Speculum – strawberry cervix?
    • High vaginal swabs
    • Endocervical swabs
    • Urine dipstick and MC&S
  • Bloods:
    • WCC
    • CRP
    • HIV serology
  • Imaging:
    • TVUSS
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16
Q

Management of chlamydia, gonorrhoea, BV, TV and syphilis

A
  • Chlamydia and gonorrhoea:
    • IM ceftriaxone 1g stat
      • 2 weeks PO doxycycline 100mg BD and metronidazole 400mg BD
  • BV and TV
    • Metronidazole 500mg PO for 7 days
  • Syphilis
    • IM benzylpenicillin
17
Q

Investigations for urinary incontinence

A
  • Examination – abdominal masses and calculate BMI
  • Bimanual
  • Speculum
  • Urine dipstick and MC&S
  • Urinary studies:
    • Bladder diary
    • Urodynamic studies
18
Q

Management of urogenital prolapse

A
  • conservative: weight loss, pelvic floor muscle exercises, stop smoking, avoid heavy lifting
  • ring pessary
  • cystocele/cystourethrocele: anterior colporrhaphy, colposuspension
  • uterine prolapse: hysterectomy, sacrohysteropexy
  • rectocele: posterior colporrhaphy
19
Q

Management of stress incontinence

A
  • Pelvic floor exercises
  • Duloxetine
  • Retropubic mid-urethral tape procedures
20
Q

Management of urge incontinence:

A
  • Bladder retraining
  • Oxybutynin/tolterodine
  • Mirabegron
21
Q

Which complex of muscles makes up the bulk of the perineum?

A

Levator ani which is made of the:

  • Puborectalis
  • Pubococcygeus
  • iliococcygeus
22
Q

What are the four stages of uterine prolapse?

A
  • Stage 1: cervix is in the upper half of the vagina
  • Stage 2: cervix is at the introitus
  • Stage 3: cervix protrudes out of the introitus
  • Stage 4: procidentia – uterus is outside the vagina
23
Q

Risk factors for urinary incontinence

A
  • advancing age
  • previous pregnancy and childbirth
  • high body mass index
  • hysterectomy
  • family history
24
Q

Investigations for ovarian cancer

A
  • Examination: abdominal mass
  • Speculum
  • Bloods:
    • FBC – anaemia
    • U&Es – obstruction and renal failure
    • LFTs
    • Clotting factors
    • CA-125
  • Imaging:
    • TVUSS
    • MRI for surgical planning
  • Calculate RMI and if >250 refer to MDT
25
Q

Management of ovarian cancer

A
  • Surgical:
    • Staging laparotomy à TAH/BSO and assessment of pelvic lymph nodes
    • Advanced disease à TAH/BSO + primary debulking of omentum
  • Adjunctive platinum based chemotherapy
26
Q

Risk factors for ovarian cancer

A
  • Family history: mutations of the BRCA1 or the BRCA2 gene
  • Age
  • HRT
  • Endometriosis
  • Smoking
  • Overweight
  • Potentially PCOS
  • Many ovulations
    • Early menarche
    • Late menopause
    • Nulliparity
27
Q

Most common histological subtype of ovarian cancer

A

Serous cystadenocarcinoma

28
Q

Describe the FIGO staging of ovarian cancer

A
  1. Confined to ovaries
  2. Confined to pelvis
  3. Confined to abdominal peritoneum/positive retroperitoneal or inguinal lymph nodes
  4. Distant mets
29
Q

Causes of secondary amenorrhoea

*

A
  • Anorexia/low BMI
  • Hypo or hyperthyroidism
  • PCOS
  • Post hormonal contraceptive especially progesterone injection
  • Asherman’s syndrome or cervical stenosis
30
Q

Investigations for secondary amenorrhoea

A
  • Examination: signs of anorexia e.g. muscle wasting and lanugo hair
  • Urine pregnancy test
  • Bloods:
    • FBC – anaemia
    • Hormone profile
      • Low gonadotrophins à premature ovarian failure
      • Prolactin à prolactinoma
      • Raised androgens/testosterone à PCOS
      • Oestradiol
    • TFTs
31
Q

How do you manage PCOS for patients trying to get pregnant?

A
  • Weight loss
  • Clomiphene citrate
  • +/- metformin
  • Letrozole
  • Laparoscopic ovarian drilling
  • Gonadotrophins
32
Q

Management of subfertility caused by tubal disease?

A
  • Salpingography + tubal catheterisation
  • Hysteroscopic tubal cannulation
  • Hysteroscopic adhesiolysis
33
Q

Causes of infertility

A
  • male factor 30%
  • unexplained 20%
  • ovulation failure 20%
  • tubal damage 15%
  • other causes 15%
34
Q

Who would you offer intrauterine insemination to?

A
  • People who can’t have vaginal intercourse due to physical or psychosexual disability
  • Same sex couples
  • Conditions that require specific consideration in relation to method of conception e.g. after sperm washing of HIV+ man
35
Q

What is prediction of IVF success based off?

A
  • Female age
  • Number of previous Tx cycles
  • Previous pregnancy history
  • BMI
  • Lifestyle
    • Alcohol
    • Smoking
    • Caffeine
36
Q

Symptoms of menopause

A
  • Vasomotor symptoms:
    • Hot flushes
    • Night sweats
    • Palpitations
  • Urogenital symptoms:
    • Vaginal dryness/itching
    • Dyspareunia
    • Urinary frequency, urgency, dysuria and frequent UTIs
  • Psychological symptoms:
    • Mood fluctuations
    • Insomnia
    • Depression
37
Q

Diagnosis of hyperemesis gravidarum

A
  • 5% pre-pregnancy weight loss
  • Dehydration
  • Electrolyte imbalance

PACES 2 (5 decks)

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