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Gynae conditions Flashcards

1
Q

What are uterine polyps ?

A

benigns growths attached to the inner wall of the uterus that extends in to the uterine cavity

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2
Q

What age are uterine polyps more common?

A

perimenopause and post-menopause

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3
Q

Risk factors for uterine polyps?

A 
hypertension
obesity
tamoxifen
hrt
hx of cervical polyps
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4
Q

symptoms of uterine polyps

A 
irregular bleeding 
bleeding between periods
heavy periods
bleeding after menopause
can be asymptomatic
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5
Q

treatment of uterine polyps

A

GA surgery - curettage with or without hysteroscopy

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6
Q

Can uterine polyps be cancerous

A

Yes some can be precancerous

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7
Q

what are cervical polyps?

A

benign growth on surface of cervical canal

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8
Q

who are cervical polyps most common in?

A

post menarche and pre-menopausal women

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9
Q

symptoms of cervical polyps

A

abnormal bleeding
-heavy
-post menopause bleeding
bleeding after sex

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10
Q

can cervical polyps be asymptomatic

A

yes

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11
Q

investigations needed for uterine polyps

A

Vaginal US

Hysteroscopy

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12
Q

investigations needed for cervical polyps

A

can be seen as red/purple projections from the cervical canal in pelvic examination

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13
Q

treatment for cervical polyps

A

removed using forceps

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14
Q

are cervical polyps likely to re-grow

A

no

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15
Q

what is endometritis?

A

inflammation of the lining of the uterus - usually caused by infection. Can be pregnancy related or non-obstetric

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16
Q

Who is most likely to get endometritis?

A

post-partum women, 1-3% of births.

10 x more common if have caesarean

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17
Q

what causes endometritis?

A

Thought to be a lower gential tract infection that has spread up to infect the endometrium.

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18
Q

risk factors for endometritis (post-partum)

A 
c-section
prolonged labour, rupture of membranes
intrapartum chorioamnionitis
obesity 
DM
HX of pelvic infection
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19
Q

Symptoms of endometritis (post-partum)

A 
fever
foul, profuse, blood discharge
abdo pain
abnormal bleeding
dyspareunia
dysuria
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20
Q

signs of endometritis (post-partum)

A

tender, bulky uterus on abdo exam
raised temp
tachycardia

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21
Q

investigations for endometritis (post partum)

A

Blood cultures
Midstream urine
high vaginal swab

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22
Q

treatment of endometritis (post partum)

A

antibiotics (IV) - go to hospital

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23
Q

What is cervical ectropion?

A

a condition where the central (endocervical) columnar epilethelium protrudes out through the external os of the cervix and onto the vaginal portion of the cervix and undergoes transformation

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24
Q

What is the transformation seen in cervical ectropion

A

Columnar epithelium from the endocervix becomes stratified squamous epithelium

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25
Q

symptoms of cervical ectropion

A

usually asymptomatic
can cause discharge, bleeding
pain before/after sex

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26
Q

investigations for cervical ectropion

A

cervical smear

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27
Q

treatment of cervical ectropion

A

usually self-limiting

cauterising is main treatment

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28
Q

what is atrophic vaginitis?

A

inflammation of the vagina due to the thinning and shrinking the tissues as well

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29
Q

Cause of atrophic vaginitis?

A

lack of oestrogen after the menopause. oestrogen normally keeps the tissues supple and moist and thickens the lining of the vagina. less oestrogen = thinning of tissues.

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30
Q

symptoms of atrophic vaginitis

A

bleeding
painful sex
vaginal discharge

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31
Q

how is atrophic vaginitis diagnosed?

A

clinical diagnosis

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32
Q

treatment for atrophic vaginitis

A

Cream or pessary containing oestrogen

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33
Q

what are vaginal ulcers?

A

a discontinuity of the skin or mucous membranes - the membrane is lost and the underlying tissue is exposed

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34
Q

who is most affected by

vaginal ulcers?

A

Younger women due to STI nature

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35
Q

Causes of vaginal ulcers?

A

Herpes
Syphilis
Bacterial/fungal infections

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36
Q

symptoms of vaginal ulcers?

A 
Open ulcers or cuts
pain +/- burning sensation
abnormal discharge
itching 
dry vagina 
dyspareunia 
dysuria 
Bleeding
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37
Q

Treatment of vaginal ulcers

A

STIs are most common cause so treat them!

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38
Q

what is vaginal cancer?

A

squamous cell carcinoma involving the posterior wall of the upper third of the vagina

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39
Q

How common is vaginal cancer?

A

RARE - 1% of gynae cancers

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40
Q

symptoms of vaginal cancer

A

bleeding

may have Gi/urinary symptoms if invaded rectum/bladder

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41
Q

how is vagina cancer diagnosed?

A

Colposcopy

biopsy, cervical cytology, endometrial biopsy

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42
Q

Is vaginal cancer treated with chemotherapy?

A

NO

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43
Q

Treatment of vaginal cancer?

A

depends on stage.

surgery and radiotherapy are very effective in early stages

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44
Q

what is endometriosis

A

The presence of tissue resembling endometrial glands and stroma outside the uterine cavity which induces chronic inflammatory reaction

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45
Q

Where does endometriosis commonly occur?

A

ovary, rectrovaginal pouch, uterosacral ligaments, o the pelvic peritoneum

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46
Q

How does endometriosis cause the pain?

A

The deposits of tissue is oestrogen-dependent and responds to hormonal changes in the menstural cycle

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47
Q

How common is endometriosis?

A

Common - most commonly diagnosed in women aged 30-40, prevalence: 10% of all women

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48
Q

Does endometriosis affect fertilty?

A

Yes it can but not necessarily so. As the extent of endometriosis becomes greater the scar tissue increases which can decrease natural fertility

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49
Q

risk factors for endometriosis

A

early menarche/late menopause
short menstrual cycles/long duration of menstrual flow
genetic - first degree relatives
obstruction to vaginal outflow

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50
Q

what are protective factors for endometriosis

A

Multiparity and use of oral contraceptives

51
Q

symptoms of endometriosis

A 
can be asymptomatic
dysmenorrhoea
dyspareunia
cyclical or chronic pelvic pain
subfertility
heavy + frequent periods
52
Q

What are the symptoms of extra-pelvic endometriosis?

A

pain or bleeding at the time of mensturation at the site of the pathology: eg haematuria, haemothorax

53
Q

What condition can endometriosis present similar to?

A

Irritable bowel syndrome

54
Q

What is the gold standard investigation for endometriosis?

A

Laparoscopy with histological confirmation

55
Q

What investigations are currently carried out for endometriosis?

A

trans-vaginal USS

56
Q

Treatment for endometriosis

A

don’t treat if asymptomatic
give analgesia/NSAIDS 1st line
Combined pill can help
Surgery

57
Q

what is the menopause?

A

the cessation of the menses for >12 months due to los of ovarian activity

58
Q

causes of menopause

A

natural physiology of age leading to reduced oestrogen levels

59
Q

symptoms of the menopause

A

menstural irregularity followed by cessation
vasomotor disturbance: sweats, palpitations, hot flushes
vaginal dryness
dyspareunia (painful+difficult)

60
Q

signs of menopause

A

anovulatory cycles
reducing oestrogen levels
rising FSH levels

61
Q

investigations for menopause

A

may not be necessary unless worried

62
Q

what level does FSH need to be at for menopause to be diagnosed?

A

> 30 IU/L

63
Q

What has HRT been associated with?

A

breast cancers, endometrial cancer

64
Q

what other hormone is HRT given with

A

Progesterone, as unopposed oestrogen can be carcinogenic and cause endometrial hyperplasia.

65
Q

what non-medical treatment can be offered to women after the menopause?

A

counselling for pyschosocial and physical symptoms

66
Q

what is Pelvic inflammatory disease (PID)

A

infection of the upper female genital tract, including the uterus, fallopian tubes, and ovaries

67
Q

What is the most common factor of PID

A

sexual factors

68
Q

What is the causative organism of chlamydia?

A

Chlamydia trachomatis

69
Q

What is the causative organism of gonorrhoea?

A

neisseria gonorrhoeae

70
Q

What are the risk factors for PID?

A

The risk factors for STIs
Termination of pregnancy
intrauterine contraceptive device inserted in the previous 20 days

71
Q

What are the symptoms of PID?

A

Bilateral lower abdo pain
Deep dyspareunia
abnormal vaginal bleeding
purulent vaginal or cervical discharge

72
Q

what are the signs of PID?

A 
lower abdo tenderness
cervical discharge
cervical motion tenderness
fever >38 (can be apyrexial)
urinary symptoms
73
Q

Define adnexa?

A

The appendages of the uterus, namely the ovaries, fallopian tubes and ligaments that hold the uterus in place

74
Q

What are the risk factors for STIs?

A

Young, new sexual partner, multiple sexual partners, lack of barrier contraception, lower socio-economic group

75
Q

Investigations for PID

A

Pregnancy test
Cervical swabs for STIs - positive result supports diagnosis, negative result does not exclude PID
Endocervical swabs
USS

76
Q

General treatment for PID

A

analgesia
referral to GUM for contact tracing
treat all partners for chlamydia
empirical treatment for chlamydial infection + gonorrhoea if unwilling to get screened

77
Q

complications of PID

A

ectopic pregnancy
infertility
pelvic pain

78
Q

treatment for mild-mod disease

A

ceftriaxone 500mg as a single IM dose + doxycycline 100mg PO BD, metronidazole 400mg BD for 14 days

79
Q

what investigation is necessary if patients fail to respond to antibiotic therapy

A

Laparoscopy to confirm diagnosis or to make an alternative diagnosis

80
Q

what complications is PID associated with in pregnancy

A

preterm delivery

foetal morbidity

81
Q

how can PID be prevented

A

barrier contraception

regular chlamydia/STI testing

82
Q

what is premenstrual syndrome (PMS)?

A

name given to physical, psychological and behavioural symptoms that occur in the 2 weeks before a woman’s monthly period.

83
Q

cause of PMS

A

fluctuating hormones during the menstrual cycle

84
Q

risk factors for PMS

A

lack of exercise
being overweight
stress
poor diet

85
Q

physical symptoms of PMS

A

bloating
breast pain
insomnia

86
Q

psychological symptoms of PNS

A

mood swings
feeling irritable/depressed
loos of interest in sex
poor concentration

87
Q

signs

A

acne flare ups
headache
joint/muscle pain

88
Q

investigations for PMS

A

not required

might be useful to keep a symptom diary

89
Q

treatment for mild/mod PNS

A 
lifestyle changes
improve diet
exercise
learn stress relief techniques
regular sleep 
NSAIDs if in pain
90
Q

Treatment for severe PNS

A

psychological therapy
hormone meds eg the pill
antidepressants - SSRIs
diuretics if bloating is bad

91
Q

what needs to be present in order for PMS to be diagnosed?

A

there needs to be symptom free intervals between a girls periods

92
Q

what is polycystic ovarian syndrome (PCOS)?

A

complex endocrine disorder which includes hirsutism and acne

93
Q

what are the symptoms of PCOS caused by

A

excessive androgens

94
Q

complications of PCOS

A

infertility due to anovulation

impaired glucose tolerance and DM type 2

95
Q

how many of the 3 criteria need to be filled to make a diagnosis of PCOS

A

2

96
Q

what are the 3 criteria for the diagnosis of PCOS

A
  1. infrequent/no ovulation
  2. clinical/biochemical signs of hyperandrogenism or elevated levels of free testosterone
  3. polycystic ovaries on USS
97
Q

if polycystic ovaries are found does this establish the diagnosis?

A

no -not one their own

98
Q

which 3 hormones should be tested to help with the diagnosis of PCOS?

A

Total testosterone
sex hormone-binding globulin
free androgen index

99
Q

what will the findings of the hormone tests for PCOS be?

A

total testosterone: normal/mod high
sex hormone-binding globulin: normal to low
Free androgen index: normal or elevated

100
Q

Do polycystic ovaries have to be found to make a diagnosis of PCOS

A

No

101
Q

what should be measured to rule out other causes of oligomenorrhoea and hyperprolactinaemia?

A
  1. LH and FSH
  2. Prolactin - maybe mildly elevated
  3. TSH
102
Q

treatment for PCOS

A

lifestyle advice - weight loss
screening for DM
treatment to prevent endometrial hypoplasia

103
Q

what do women with PCOS and infertility require

A

assessment for possible causes
weight loss advice if neccessary
may need referral to secondary care for fertility treatment

104
Q

what test should women who are pregnant with PCOS be offered?

A

GTT before 20 weeks

105
Q

spontaneous miscarriage

A

loss of pregnancy before 24 weeks of gestation. Ectopic pregnancy is not included.

106
Q

causes of spontaneous miscarriage

A 
often no known cause
abnormal foetal development
genetically balanced parental translocation 
incompetent cervix
infections
placental failure
107
Q

risk factors for spontaneous miscarriage

A 
age (most frequent in women >30 yrs, even more common >35ys)
increased no of births
smoking >14 per day doubles risk
excess alcohol 
uncontrolled DM
108
Q

presentation of spontaneous misscarriage

A

vaginal bleeding + pain that is worse than period pain is most common

109
Q

what % of women with threatened miscarriage will miscarry?

A

approx 50% - increases if they have increasing bleeding

110
Q

what should you look for in first trimester bleeding?

A
  • is the patient shocked through blood loss?
  • products of conception in the cervical canal?
  • is the cervical os open?
  • is the size of the uterus appropriate for dates?
111
Q

what is the most important diagnosis to exclude in spontaneous misscarriage

A

ectopic pregnancy

112
Q

investigations needed for spontaneous miscarriage

A

USS - transvaginal, 98% of miscarriages can be diagnosed this way

113
Q

what is serum hCG

A

a hormone produced by the placenta after implantation - used in pregnancy tests. used to exclude ectopic in women with a complete miscarriage

114
Q

treatment of spontaneous miscarriage

A

can treat conservatively - wait to see if resolve naturally for 7-14 days

115
Q

what are the indications for surgical management of spontaneous miscarriage?

A

persistent excessive bleeding, haemodynamically unstable.

infected retained tissue

116
Q

what is the surgical procedure for removal after miscarriage

A

manual vacuum aspiration

117
Q

what is a threatened miscarriage?

A

mild symptoms of bleeding. usually little/no pain. cervical os is closed

118
Q

what is an inevitable miscarriage

A

cervical os is open - usually presents with heavy bleeding, clots and pain.
pregnancy will not continue and go to incomplete/complete miscarriage

119
Q

what is incomplete miscarriage

A

when the products of conception are partially expelled. these are often unrecognised missed misscarriages

120
Q

what is a missed miscarriage?

A

the foetus is dead but retained.

uterus small for dates

121
Q

how do missed miscarriages present?

A

uterus small for gestational date
hx of threatened miscarriage and persistent, dirty brown discharge.
early pregnancy symptoms decreased/gone

122
Q

what are recurrent miscarriages

A

three or more in the first trimester
or 3 consecutive
or 1 in second trimester

123
Q

what is a molar pregnancy?

A

over growth of the placenta (all or part) in trophobalstic disease

GOSH (1 decks)

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