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
2
Q
Ddx for abnormal uterine bleeding
A
- Dysfunctional uterine bleeding
- Fibroids
- Endometriosis
- Endometrial cancer
- Miscarriage
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
4
Q
Differentials for postmenopausal bleeding
A
- Endometrial cancer
- Atrophic vaginitis
- Cervical/vulval cancer
- Cervical polyps
5
Q
Investigations for postmenopausal bleeding
A
- Abdominal examination looking for masses
- Bimanual examination
- Speculum
- 2 week wait referral:
- TVUSS
- Hysteroscopy and biopsy
6
Q
Management of endometrial cancer
A
- Localised disease:
- TAH +BSO
- Progesterone therapy if unable to tolerate surgery
- Severe disease:
- Adjuvant radiotherapy
7
Q
RF for endometrial cancer
A
- Obesity
- Nulliparity
- Early menarche and late menopause
- Unopposed oestrogen therapy
- Diabetes mellitus
- Tamoxifen
- PCOS
- HNPCC
8
Q
Subtypes of endometrial cancer
A
- Endometrioid
- Mucinous
- Secretory
- Serous
- Clear Cell
9
Q
Figo staging of endometrial cancer
A
10
Q
Differentials for chronic pelvic pain
A
- Endometriosis
- PID
- Adenomyosis
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
- TVUSS
- Laparoscopic exploration - endometriosis
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
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
14
Q
Complications of PID
A
- Fitz-Hugh-Curtis syndrome
- Ectopic pregnancy in future
- Tubal infertility
- Chronic pelvic pain
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
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
Management of ovarian cancer
* 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
Risk factors for ovarian cancer
* 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
Most common histological subtype of ovarian cancer
Serous cystadenocarcinoma
28
Describe the FIGO staging of ovarian cancer
1. Confined to ovaries
2. Confined to pelvis
3. Confined to abdominal peritoneum/positive retroperitoneal or inguinal lymph nodes
4. Distant mets
29
Causes of secondary amenorrhoea
*
* Anorexia/low BMI
* Hypo or hyperthyroidism
* PCOS
* Post hormonal contraceptive especially progesterone injection
* Asherman’s syndrome or cervical stenosis
30
Investigations for secondary amenorrhoea
* 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
How do you manage PCOS for patients trying to get pregnant?
* Weight loss
* Clomiphene citrate
* +/- metformin
* Letrozole
* Laparoscopic ovarian drilling
* Gonadotrophins
32
Management of subfertility caused by tubal disease?
* Salpingography + tubal catheterisation
* Hysteroscopic tubal cannulation
* Hysteroscopic adhesiolysis
33
Causes of infertility
* male factor 30%
* unexplained 20%
* ovulation failure 20%
* tubal damage 15%
* other causes 15%
34
**Who would you offer intrauterine insemination to?**
* 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
**What is prediction of IVF success based off?**
* Female age
* Number of previous Tx cycles
* Previous pregnancy history
* BMI
* Lifestyle
* Alcohol
* Smoking
* Caffeine
36
Symptoms of menopause
* 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
Diagnosis of hyperemesis gravidarum
* 5% pre-pregnancy weight loss
* Dehydration
* Electrolyte imbalance
