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Sheff 3a > Gynae Flashcards > Flashcards

Gynae Flashcards

1
Q

Outline the hormonal involvement in start of puberty for girls

A

Hypothalamus - GnRH pulses

  • > Pit - FSH + LH
  • > Oestrogen release from ovaries
  • > 2ndary characteristics (Thearche is first
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2
Q

3 phases of me trial cycle? What happens to endometrium at each? Key hormonal changes?

A

Day 1-4: Menstruation
Endometrium shreds

Day 5-13: Proliferative / follicular
Proliferative endometrium
-GnRH -> FSL/LH release -> follicular growth
-Follicles produce oestrogen which has -ve feedback (only one follicle matures)
-Increased oestrogen levels -> LH surge followed by ovulation around 36 hrs later

Day 14-28: Secretory (luteal) phase
Secretary endometrium
-Follicle becomes corpus luteum -> produce oestrogen and >progesterone
-Progesterone peak at day 21
-Lack of fertilisation -> endometrium breaks down

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3
Q

What is androgen insensitivity syndrome?

A 
Genetically male 46XY 
Female phenotype (5a-reductive deficiency)
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4
Q

What is the difference between hypergonadotropic hypogonadism and hypogonadotrophic hypogonadism and Egs?

A

Hypergonadotrophic - Ovarian
Congenital - turner
Acquired - PCOS

Hypogonadotrophic - Hypothalamic
Psychological - stress, low weight
Low GnRH

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5
Q

Causes of outflow tract obstruction in amenorrhea ?

A

Vaginal agencies
Imperforate hymen
Transverse vaginal septum

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6
Q

Mx of prolactin secreting adenomas?

A

Bromocriptine

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7
Q

How do adrenal / thyroid cause amenorrhea? What would you see in hypothyroidism?

A

Overactive / under-active thyroid can cause

Hypothyroid -> raised prolactin and amenorrhea

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8
Q

Which ligaments connect uterus to cervix? Pelvic wall?

A

Uterosacral and cardinal

Broad (continuous with Fallopian tubes)

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9
Q

Why can HB be low and high with fibroids ?

A

Menorrhagia / IMB -> low

Fibroids can secrete erythropoietin -> high

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10
Q

Endocervix and ectocervix epithelium ? What happens in cervical ectropion ?

A

Endo - columnar
Ecto - Squamous (continuous with vagina)

Endocervix is visible - Often normal in pregnancy / COCP

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11
Q

Morphological damage in hpv

A

Koiliocytosis

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12
Q

Follow up of CIN 1? CINII/III

A

6/12, 1 year, 2 year

As above then yearly for 10 years

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13
Q

Screening for Cervial ca every?

A

25-49 - every 3 ears

Every 5 years until 65

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14
Q

Staging of cervical ca named?

A

FIGO

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15
Q

Mx of cervical Ca if no LN? LN+ve?

A

-ve - Radical abdominal hysterectomy

+ve - Chemo radio

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16
Q

Basics of lichen simplex? Lichen Planus? Lichen sclerosis?

A 
Simplex 
Long Hx of itching and soreness 
-may be inflamed and thickened with hyper/Po pigmentation 
-Avoid irritants (Eg soap) 
Mx - Emolient, steroid cream

Planus
Purplish lesions in Angelita area
Mx- High strength steroid creams

Sclerosis

  • Usually post menopausal
  • Itching and sorenes
  • Pink-white papules which coalesce to form parchment like skin fissures
  • Risk of vulval Ca
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17
Q

What is a bartholian cyst? Complication?

A

Glands behind labia minora get blocked -> cyst

Staph / ecoli infection -> abscess

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18
Q

2 types of VIN ? Mx?

A

Usual - HPV
Most common in <45

Differentiated - due to lichen sclerosis
>45

Local excision, lazer therapy, topical immunomodulators

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19
Q

What is clear cell Ca? Who gets it?

A

Adenocarcinoma of vagina

-Daughters born to mothers given DES in pregnancy (used to prevent miscarriage)

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20
Q

Ovarian tumours
Epithelial?
Germ cell?
Sex cord?

A

Epithelial
Serous adenocarcinoma
Mucinous adenocarcinoma - risk of pseudomyoxoma peritonei if rupture

Germ cell
Teratomas
Dysgermioma

Sex cord
Granulosa cell tumours - secrete high levels of inhibit and oestrogen
Thecomas - Can secrete oestrogen and androgens
Fibromas - Meigs

21
Q

Where are mets to ovary commonly from?

If they contain signet-ring cells what are they?

A

Breast and GI

Krukenberg tumours

22
Q

2 antimuscarinic drugs for OAB (urge) incontinence?

A

Oxybutynin

Tolterodine

23
Q

Drug for IBS?

A

Mebeverine

24
Q

Which infection do you get clue cells?

25
Chlamydia called? Main complication? Syndrome? Mx?
Chlamydia trachomatis PID Rieters - Urethitis, conjunctivitis, arthritis Doxycycline or azithromycin
26
Gonorrhoea called? Under microscope? Mx?
Neisseria gonorrheoa Gram -ve diplococcus Ceftriaxone
27
Genital warts caused by? | Mx?
HPV 6+11 Topical imiquimod cream Cryotherapy
28
Cause of herpes? Features? MX?
HSV -2 (1 but less common) Primary infection the worst - Multiple painful vesicles (little blisters) -often get local lymphadenopathy, dysuria and systemic Sx Acyclovir
29
Cause of syphilis? Stages? Important thing to remember? Mx?
Treponema pallidum 1- painless ulcer 2- rash, flu like + warty genital/anal growths 3 [rare] - Dementia, gummata of skin and bone 1 and 2 are carry high risk of congenital infection in pregnancy IM penicillin
30
Trichomonas cause? Key features? Mx?
Trincomonas vaginalis Grey/green discharge - itch and soreness Dyspareunia Strawberry cervix Metronidazole
31
``` Screening Asx female? Sx? Asx male? Sx? Asx MSM? Sx? ```
Female Asx - cervical swab for C+G, blood for Syphillis and HIV Sx - Urethral swab for G culture, Triple swab Male Asx - First void urine for C+G, Blood for S+HIV Sx - + Urethral swab for G culture MSM Asx - Urethral swab for G culture, first void urine C+G, rectal/pharyngeal swab for C+G, Blood for S+HIV+HepB/C Sx - +urethral and rectal slides -> gram stain + culture
32
What makes up the triple swab
2x endocervical for C+G | High vaginal for BV, trichomonas + thrush
33
5 parts of Fraser criteria ?
1 - able to UNDERSTAND 2- doctor TRIED TO PERSUADE to inform parents (or allow him to) 3- She will CONTINUE to have intercourse without contraception 4- Her PHYSICAL / MENTAL health is likely to suffer 5- Her BEST INTERESTS require the prescriber to give contraception ± treatment without parental consent
34
How does the COCP work? Advantages? (Give 2) Disadvantages? CIs?
Inhibiting ovulation Thickening cervical mucus Thinning endometrium Advantages - Reversible, reliable, 12 hour window - Decreased dysmenorrhea and menorrhagia - protective against ovarian + endometrial Ca - Reduces risk of PID Disadvantages - No STI protection - risk of thromboembolic disease - Decreased effectiveness if D+V - cant be used in smokers >35 ``` CI Smokers >35 BMI >35 Hx of VTE Migraine with aura ```
35
``` POP How does it work? What’s in it? Advantages? Disadvantages? What to do if a missed dose? ```
Thickens cervical mucus Thins endometrium Decreases tubal motility Stops ovulation Cerazette - desogestrel, Micronor - norehisterone Advantages - Suitable for smokers >35, migraine with aura, HTN - Avoids oestrogenic side effects - Breast tenderness, headache, nausea Disadvantages - Less effective than COCP - 3hr window (cerazette is 12hr) - Functional ovarian cyst may develop - Can disrupt menstrual pattern If missed by 3hr (12 for cerazette) then another should be taken ASAP and use condoms for 2 days
36
Depo provera given how often? Mechanism? Advantages? Disadvantages?
Progesterone infection every 12 weeks Suppresses FSH+LH -> inhibits ovulation Advantages - little user dependence -> good for compliance - Over half are amernorrhoeic after 1 year Disadvantages - Irregular bleeding for first 3/12 - Delay in return to fertility - Weight gain (2kg in 1st year) - Bone density reduced - regained after stoppping
37
Implant mechanism ?> how long does it last? Advantages? Disadvantages?
Progesterone - suppress LH/FSH -> inhibits ovulation 3 years Advantages - Low dose, long acting, reversible - Reduces dysmenorrhea & Montreal blood loss Disadvantages - Irregular bleeding for up to 1 year - Infection at implant site
38
Inter-uterine system hormone? How long? Advantages? Disadvantages?
Levonorgestrel (progesterone) 5 years Advantages - Very effective - few systemic side effects - Decreased dysmenorrhea and menstrual blood loss - decreased with of ectopic Disadvantages - Risk of PID after fitting - Irregular bleeding especially in first 3/12
39
What is the morning after pill? How long can it be taken? Success?
1.5mg of levonorgestrel 95% success in 24 hours 55% at 72 hrs
40
What can be used as non hormonal emergency contraception? Disadvantages?
Copper IUD -Most effective method after 72 hrs Painful on insertion Risk of PID Risk of uterine perforation
41
Common side effects of progesterone ?
``` Depression Weight gain Acne Pre menstrual syndrome like sx Irregular bleeding Reduced libido ```
42
Oestrogenic side effects
``` Nausea Headaches Increased mucus Fluid retention & weight gain HTN Breast tenderness & fullness ```
43
3 non hormonal contraception
Barrier - condom / caps Natural family planning Lactational amenorrhea - when fully breast feeding Male / female sterilisation
44
2 methods for female sterilisation
Filshie clips | Enssure micro inserts
45
Primary vs secondary subfertility
Primary - never conceived
46
4 conditions required for pregnancy?
Egg must be produced -anovulation Adequate sperm Sperm must reach egg -Tubal Egg must implant
47
Physiology of sperm production | What is seen in normal semen analysis
LH -> leydig cells -> testosterone ->serotonin cells -synthesis and transport of sperm Volume >2ml Motility >50% Number >20million Morphology >40% normal
48
Causes of abnormal sperm release
Idiopathic Drug exposure - alcohol, smoking, industrial chemicals, anabolic steroids Varicocele ``` Kartagner’s syndrome - ciliary dyskinesia CF - congenital vas deferns absence Retrograde ejaculation Mumps Anti-sperm antibodies ```
49
Methods of IVF ? Indications?
Inter uterine insemination - Unexplained sub-fertility, cervical / sexual problems - Cheaper but less effective than IVF In-vitro fertilisation - Doesn’t require patent tubes - Does need ovarian reserve -> cant use in ovarian dysgenesis / failure Intercytoplasmic sperm injection (ICSI) -useful for severe male factors Oocyte donation -genetic disease, premature ovarian failure

Sheff 3a (30 decks)

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