gynae finals Flashcards
what are the symptoms of fibroids ?
Asymptomatic
Menorrhagia
bulk related symptoms like lower abdominal pain, cramps, urinary symptoms
How are uterine fibroids managed ?
Medical : GnRH agonists to reduce the size of fibroids - short term use
Surgical : Myomectomy, hysteroscopic endometrial ablation, hysterectomy
what is a common complication of fibroids during pregnancy
Red degeneration where the fibroid haemorrhages into tumour.
How do you manage cervical cancer by stage ?
1A : gold standard is hysterectomy and lymph node of clearance
to maintain fertility : Cone biopsy with negative margins
1B :
1B1 : Radiotherapy with concurrent chemotherapy ( cisplatin)
1B2 : radical hysterectomy with pelvic node dissection
II,III : radiation with chemotherapy
IV :Radiation and / or chemotherapy
palliative chemotherapy
what are the side effects of GnRH agonists
menopausal symptoms : Hot flushes, vaginal dryness
loss of bone mineral density
management of cervical smears : hrHPV +ve but cytologically normal
repeat after 12 months
normal : normal recall
still hrHPV : repeat after 12 months
normal : normal recall
still hrHPV +ve : colposcopy
management of cervical smears : ‘‘inadequate’’ sample
repeat sample in 3 months
2 consecutive inadequate samples –> colposcopy
what is the HPV first system ?
a sample is tested for high-risk strains of human papillomavirus (hrHPV) first and cytological examination is only performed if this is positive.
___________________is the most common treatment for cervical intraepithelial neoplasia.
Large loop excision of transformation zone (LLETZ)
what is the lifestyle advice for PMS ?
regular, frequent (2–3 hourly), small, balanced meals rich in complex carbohydrates
What is the most common complication of myomectomy
Adhesions
how do you menorrhagia if
- Patient does not require contraception
- Patient requires contraception
- Mefenamic acid 500 mg tds ( if dysmenorrhoea) / tranexamic acid tds
2 IUS : Mirena
COCP
what is adenomyosis ? What are its features ?
It is the presence of endometrial tissue within the myometrium.
features include -
dysmenorrhoea
menorrhagia
enlarged, boggy uterus
what is the first line investigation for adenomyosis ?
TV USS
what is the management of adenomyosis
tranexamic acid : menorrhagia
GnRH agonists
uterine artery embolisation
hysterectomy - definitive
what symptoms are suggestive of ectopic pregnancy ?
Pain and abdominal tenderness
pelvic tenderness
cervical motion tenderness
how do you manage bleeding in the fist trimester ?
> = 6 weeks
refer to EPAU
TVUSS
< 6 weeks
if no pain or risk factors of ectopic - expectant management
- return if bleeding continues
repeat urinary pregnancy to test after 7-10 days - negative pregnancy test : miscarriage
What is Fitz Hugh Curtis syndrome ?
Peri-hepatic inflammation secondary to chlamydia presenting with RUQ discomfort
what is the medical management of MTP
Mifepristone and Misoprostol followed by a pregnancy test in 2 weeks to confirm the pregnancy has ended ( multi-level pregnancy test)
what are the risk factors for vaginal candidiasis ?
Diabetes mellitus
Drugs : Antibiotics / steroids
pregnancy
Immunosuppression : HIV
what are the features of vaginal candidiasis
cottage cheese non offensive discharge
vulvitis : superficial dyspareunia, dysuria
itch
erythema
what is the management of vaginal candidiasis
- Oral Fluconazole 150 mg as single first dose
-Clotrimazole 500 mg intravaginal pessary single dose
What are the features of a complete hydatidiform mole ?
vaginal bleeding
uterus size greater than expected for gestational age
abnormally high serum hCG
ultrasound shows snow storm appearance
what is the most common site of ectopic pregnancy ?
Ampulla of fallopian tube
whats the most common benign ovarian tumour in women < 25
Dermoid cyst ( teratoma)
what is the most common type of ovarian pathology associated with Meigs syndrome?
Fibroma
what is the most common cause of ovarian enlargement in a woman of reproductive age
Follicular cyst
what are the 2 types of physiological cysts ?
Follicular cysts and Corpus luteum cysts
what is a risk factor for women with PCOS undergoing IVF
Ovarian Hyperstimulation syndrome
what are the risk factors for endometrial cancer ?
Nulliparity
Early menarche
late menopause
unopposed oestrogen
obesity
diabetes
PCOS
tamoxifen
HNPCC
what are protective factors for endometrial cancer?
multiparity
COCP
Smoking
how is an ectopic pregnancy managed expectantly and what is the criteria ?
Size < 35 mm
Unruptured
asymptomatic
no fetal heart beat
hCG < 1000 IU/L
- management is close monitoring over 48h to see if symptoms persist / b-hcg rises
how is an ectopic pregnancy managed medically and what is the criteria ?
Size < 35 mm
Unruptured
no significant pain
no fetal heart beat
hCG < 1500 IU/L
- methotrexate + follow up
how is an ectopic pregnancy managed surgically and what is the criteria ?
size > 35 mm
can be ruptured
pain
visible fetal heartbeat
hCG > 5000 IU/L
salpingectomy : first line
salpingotomy : risk factors for infertility
what is the most common ovarian cancer
serous carcinoma
what are the risk factors for HPV ?
Smoking
HIV
early first intercourse + many sexual partners
high parity
low socioeconomic status
COCP
which type of cancer presents with Rokitansky’s protuberance ?
Teratoma ( dermoid cyst)
what is the first line management of
urge incontinence
stress incontinence
bladder retraining
pelvic floor muscle training
what is ovarian hyperstimulation syndrome and how does it present
In OHSS, ovarian enlargement with multiple cystic spaces form, and an increase in the permeability of capillaries leads to a fluid shift from the intravascular to the extra-vascular space, which has the potential to result in multiple life-threatening complications including:
Hypovolaemic shock
Acute renal failure
Venous or arterial thromboembolism
What is the referral criteria for nausea and vomiting in pregnancy ?
Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics
Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics
A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)
what is the triad for the diagnosis of hyperemesis gravidarum ?
5% pre-pregnancy weight loss
dehydration
electrolyte
what score is used to classify severity of NVP
Pregnancy-Unique Quantification of Emesis (PUQE)
what are the risk factors for hyperemesis gravidarum ?
increased levels of beta-hCG
multiple pregnancies
trophoblastic disease
nulliparity
obesity
family or personal history of NVP
