Gynae: Corrections 2 Flashcards
What condition should be suspected in patients with continuous dribbling incontinence after prolonged labour and from a country with poor obstetric services?
Vesicovaginal fistulae
1st line investigation for a vesicovaginal fistulae?
Urinary dye studies - the dye stains the urine and hence identifies the presence of a fistula.
What investigations may be required in urinary incontinence when there is diagnostic uncertainty (e.g. a bladder diary is inconclusive)?
Urodynamic studies
What investigations should women with suspected PCOS have?
1) Pelvic US
2) FSH & LH
3) Prolactin
4) TSH
5) Testosterone
6) Sex hormone-binding globulin (SHBG)
Atrophic vaginitis is a diagnosis of exclusion.
What must be ruled out first?
Endometrial cancer (use TVUS)
What should women with pruitus vulvae be advised to clean the vulval area with?
An emollient such as Epaderm or Diprobase
How soon after taking ulipristal acetate can women start hormonal contraception?
5 days after
What UKMEC is a first degree relative with VTE for the COCP?
3
Why can patients who have had a gastric sleeve/bypass/duodenal switch not have oral contraception ever again?
Due to lack of efficacy, including emergency contraception.
1ary mechanism of the desogestrel-only pill?
Inhibits ovulation
1ary mechanism of depot injection (medroxyprogesterone acetate)?
Inhibits ovulation (& thickens cervical mucus)
1ary mechanism of implant (etonogestrel)?
Inhibits ovulation
1ary mechanism of IUS (levonorgestrel)?
Prevents endometrial proliferation.
What 2 cancers in women is obesity a risk factor for?
1) endometrial
2) breast
Risk factors for cervical cancer?
1) HPV 16, 18 & 33
2) Smoking
3) HIV
4) Early first intercourse, multiple sexual partners
5) High parity
6) Lower socioeconomic status
Main mechanism of the progestogen-only pill (excluding desogestrel)?
Thickens cervical mucus
Why should oxybutynin not be used in the frail elderly population?
What is a safer alternative?
Due to increased risk of falls.
Safer alternative - solifenacin.
When is cervical screening delayed until in pregnancy?
Delayed until 3 months post-partum (unless missed screening or previous abnormal smears).
How does ovarian cancer initially spread?
By local invasion
Give some causes of endometrial hyoperplasia
- Taking oestrogen unopposed by progesterone
- Obesity
- Late menopause & early menarche
- Age >35
- Being a current smoker
- Nulliparity
- Tamoxifen
Stepwise investigations in suspected ovarian cancer (i.e. symptomatic women)?
1) Ca125
2) US
Should a Ca125 be used for ovarian cancer screening in asymptomatic women?
No
What can be given for the management of vasomotor symptoms of menopause (e.g. flushing)?
Fluoxetine (SSRI), citalopram (SSRI) or venlafaxine (SNRI)
1st line management of endometriosis?
NSAIDs and/or paracetamol
In fertility testing, when is the most appropriate time to measure serum progesterone levles?
7 days prior to next expected period (to confirm ovulation).
What are the 2 basic investigations in fertility testing?
1) Semen analysis
2) Serum progesterone (7 days prior to expected next period)
What is a potential side effect of ovulation induction?
Ovarian hyperstimulation syndrome
What is ovarian hyperstimulation syndrome (OHSS)?
A complication seen in some forms of infertility treatment.
Whilst it is rarely seen with clomifene therapy is more likely to be seen following gonadotropin or hCG treatment.
Classic features of ovarian hyperstimulation syndrome?
Mild: abdo pain, ascites
Moderate: + N&V, ascites
Severe: + oliguria, raised haematocrit, hypoproteinaemia
Critical: + VTE, ARDS, anuria, tense ascites
How is haematocrit affected in ovarian hyperstimulation syndrome?
High
1st line management of cervical intraepithelial noeoplasia (CIN)?
Large loop excision of transformation zone (LLETZ)
What is the investigation of choice for ectopic pregnancy?
TV USS
What is the most common complication following a surgical TOP?
Infection (up to 10% cases)
1st line investigation in patients with urinary incontinence?
Urinalysis - rule out UTI & diabetes
Ectopic in which location is most associated with an increased risk of rupture?
Isthmus
Management of Trichomonas vaginalis?
Oral metronidazole
What is the recommendation for a pill free period in the COCP?
There is no no medical indication for the pill free interval or withdrawal bleed whilst taking the COCP
What is the most common benign ovarian tumour in women under the age of 25 years?
Dermoid cyst (teratoma)
What is the most common cause of ovarian enlargement in women of a reproductive age?
Follicular cyst
In cases of raised FSH/LH in primary amenorrhoea, what should you consider?
Gonadal dysgenesis (e.g. Turner’s syndrome)
