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MBBS / MBChB finals > Gynae / GUM > Flashcards

Gynae / GUM Flashcards

1
Q

Syx of candidal vulvovaginitis

A

Soreness
Itching
Red skin - possible peeling, pustules or apples
White discharge

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2
Q

When to refer candidal vulvovaginitis

A

Unclear diagnosis
No improvement despite tx
Immunocompromised patient
Systemic tx needed

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3
Q

Tx of candidal vulvovaginitis

A

Topical imidazole e.g clotrimazole, ketoconazole, econazole
Alternative = topical terbinafine

If problematic itch/ inflammation add mild steroid cream

If tx ineffective try - oral fluconazole 50mg 2-4 wks

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4
Q

Which COCP may also help with acne

A

Dianette - shouldn’t be used only for contraception

Yasmin

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5
Q

What syndrome is caused by 45XO

A

Turners syndrome - absence of one X chromosome in a female

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6
Q

What is the SRY gene

A

Sex determining region of the Y chromosome

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7
Q

Clinical features of Turners Syndrome

A

Female
Short stature
Webbed neck
Wide carrying angle of elbow

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8
Q

Associated medical conditions of Turners Syndrome include

A 
Coarctation of the aorta 
IBD
Sensorineural and conduction deafness 
Renal anomalies
Endocrine dysfunction - autoimmune thyroid disease
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9
Q

What patients have streak ovaries

A

Turners Syndrome

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10
Q

How does Turners Syndrome get detected

A

At birth - clinical appearance
Childhood - short stature
Adolescence - delayed puberty

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11
Q

Is pregnancy possible in Turners Syndrome

A

Yes - usually requires egg donation

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12
Q

What is XY gonadal dysgenesis

A

XY karyotype but gonads don’t develop in testis
Phenotypically Female
Genotypically Male
Pregnancy may be possible with egg donation

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13
Q

What is 46XY disorder of sex development

A

Complete androgen insensitivity syndrome.
Testes form due to SRY gene action.
Testes secrete AMH –> regression of Müllerian ducts.
Phenotypically F - F external genitalia - no uterus.
Breast development, minimal public hair.
Short vagina

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14
Q

Genital effects of congenital adrenal hyperplasia

A

Virilization of F foetus
Enlarged clitoris
Labia fused + scrotal in appearance

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15
Q

What is Mayer-Rokitansky-Kuster-Hauser syndrome

A

Müllerian agenesis - absent / rudimentary uterus + upper vagina.
Primary amenorrhea after normal pubertal development.

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16
Q

What age defines precocious puberty

A

Before 8 in F

Before 9 in M

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17
Q

2 categories of precocious puberty

A

Central (gonadotropin dependent - 75% cause unknown.)

Peripheral (always pathological)

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18
Q

Causes of central precocious puberty

A

75% unknown

25% due to CNS malformation or brain tumour

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19
Q

Causes of peripheral precocious puberty

A

Always pathological

Oestrogen secretion - e.g. Hormone producing tumour, exogenous ingestion

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20
Q

Age definition of delayed puberty

A

No secondary sexual characteristics by age 14

Due to - hypogonadotrophic hypogonadism
- hypergonadotrophic hypogonadism

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21
Q

What causes hypogonadotrophic hypogonadism

A 
Constitutional 
Anorexia nervosa
Excessive exercise 
Diabetes 
Renal failure
(Pituitary tumour, kalman's syndrome) - rare
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22
Q

What causes hypergonadotrophic hypogonadism

A

Turner syndrome
XX gonadal dysgenesis
Premature ovarian failure
Following chemo or radio therapy for child cancers.

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23
Q

What does gonadotropin releasing hormone do

A

Controls pituitary hormone secretion
GnRH secreted in a pulsatile way to stimulate LH and FSH
GnRH at constant high dose reduces LH and FSH secretion.

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24
Q

What are buserelin and goserelin

A

GnRH agonists

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25
Q

What is the effect of oestrogen on LH

A

Low oestrogen inhibits LH production.

High oestrogen increases LH production.

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26
Q

Effect of progesterone on LH and FSH

A

Low progesterone levels increase LH and FSH productions.

High progesterone levels decrease LH and FSH productions.

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27
Q

Causes of heavy menstrual bleeding

A 
Fibroids
Endometrial polyps
Coagulation disorders 
PID
thyroid disease
Drug tx - warfarin
Copper coil
Endometrial ca
Cervical ca
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28
Q

What is the new name for dysfuntional uterine bleeding

A

Bleeding of endometrial origin

Diagnosis of exclusion

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29
Q

Investigation for heavy menstrual bleeding

A 
FBC - anaemia
Coagulation screen
Pelvic USS - fibroid, endometrial polyp, cancer
Vaginal / endocervical swabs - PID
Endometrial biopsy - endometrial cancer
TFTs
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30
Q

Management of heavy menstrual bleeding

A 
Mefenamic acid (NSAID) 
Tranexamic acid 
COCP
Norethisterone - taken from day 6 to 26 
Mirena coil
GnRH agonists - short term
Endometrial ablation 
Hysterectomy
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31
Q

What is endometrial ablation / how is it done

A

Day case
Through the vagina and cervix
Hysteroscopy before + after
Full thickness of endometrium abated

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32
Q

Causes of dysmenorrhea

A 
No cause found
Endometriosis 
Adenomyosis
PID
Cervical stenosis
Haematometra
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33
Q

Diagnosis of endometriosis

A

Laparoscopy

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34
Q

Treatment of endometriosis

A

COCP (continuously is best)
Mirena
Surgical laser ablation, diathermy or excision

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35
Q

Complication of endometriosis

A

Adhesions
‘Chocolate’ ovarian cysts = endometriomas
Infertility

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36
Q

What is adenomyosis

A

Ectopic endometrial tissue within myometrium

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37
Q

Management of dysmenorrhea

A 
NSAIDS - ibruprofen, mefenamic acid
COCP
Mirena
Low fat diet
Exercise
GnRH anaologues 
Heat
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38
Q

Causes of dyspareunia

A 
PID 
Endometriosis
Ovarian cysts
STIS
Thrush
Vaginal atrophy / lack of lubrication
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39
Q

Define primary amenorrhea

A

Failure to menstruate by age 16

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40
Q

Define secondary amenorrhea

A

Absence of menstruation for >6m that isn’t due to pregnancy, lactation or menopause

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41
Q

Causes of secondary amenorrhea

A 
Obesity
BMI <18.5
Excessive exercise 
Severe anxiety 
Pituitary tumour
Chemotherapy 
Antipsychotic drugs
Thyroid overactivity
PCOS
POF
Ashermans syndrome
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42
Q

Causes of primary amenorrhea

A 
Anatomical 
 - cervical stenosis
 - imperforate hymen
 - Müllerian agenesis
 - transverse vaginal septum
Hypothalamic-pituitary dysfunction
 - Anorexia 
 - Chronic illness 
 - excessive exercise
 - head injury
Ovarian failure
 - Turners syndrome 
 - POF
 - chemotherapy 
 - pelvic irradiation
Hypothyroidism 
Hyperthyroidism
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43
Q

Investigation of amenorrhea

A 
Pregnancy test 
Blood - LH, FSH, Testosterone 
Prolactin level
TFT
USS of ovaries 
Hysteroscopy if ashermans / cervical stenosis
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44
Q

Clinical manifestations of PCOS

A 
Menstrual irregularity - oligomenorrhoea / amenorrhea 
Hirsutism 
Subfertility
Recurrent miscarriage (50%)
Obesity
High LH 
insulin resistance 
Acanthosis nigricans
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45
Q

Diagnosis of PCOS

A

2+ of:

  • amenorrhea / oligomenorrhoea
  • hyperandrogenism
  • polycystic ovaries on USS
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46
Q

Management of PCOS

A 
COCP
Cyclical oral progesterone 
Metformin
Clomiphene
Weight reduction
Exercise
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47
Q

Management of hirsutism

A 
Eflornithine cream
Cyproterone acetate (Dianette) 
Metformin
GnRH analogues
Laser / electrolysis
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48
Q

Causes of post menopausal bleeding

A 
Atrophic vaginitis
Endometrial polyps
Endometrial hyperplasia 
Endometrial carcinoma 
Cervical carcinoma
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49
Q

Investigation of post menopausal bleeding

A

TV USS of endometrial thickness (<3mm)
Endometrial biopsy
Hysteroscopy (+curettage of polyps)

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50
Q

Management of atrophic vaginitis

A

Topical oestrogen cream
Oestrogen pessaries
Oestrogen ring pessaries

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51
Q

Management of simple or complex endometrial hyperplasia

A

Oral progesterone

Mirena

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52
Q

Management of atypical endometrial hyperplasia

A

Total abdominal hysterectomy - risk of progression to malignancy

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53
Q

Management of endometrial cancer

A

Total abdominal hysterectomy + BSO + washing +/- adjuvant therapy

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54
Q

Management of pre-menstrual syndrome

A 
Stress reduction
Exercise
Alcohol and caffeine reduction 
COCP / oestrogen patches / mirena
SSRIs
CBT
GnRH analogues 
Hysterectomy + BSO
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55
Q

Types of candida species

A 
Candida albicans
Candida tropicalis
Candida glabrata
Candida krusei
Candida parasilosis
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56
Q

Common species involved in bacterial vaginosis

A

Gardnerella vaginalis
Mycoplasma hominis
Bacteroides
Mobilincus

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57
Q

Which STI is a flagellate Protozoan

A

Trichomonas vaginalis

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58
Q

Symptoms of Trichomonas vaginalis

A

Vulval soreness + itching
Foul smelling discharge - may be frothy / green
Dysuria
Abdo discomfort
Strawberry cervix (punctate haemorrhages)

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59
Q

Diagnosis of Trichomonas vaginalis

A

Microscopy of vaginal discharge

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60
Q

Treatment of Trichomonas vaginalis

A

Metronidazole (2g) single dose

Tx both partners

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61
Q

Symptoms of bacterial vaginosis

A

Malodorous fishy discharge
Assymptomatic carriers
More prominent during menstruation
Cream / grey discharge - commonly adheres to wall of vagina

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62
Q

What do clue cells suggest

A

Bacterial vaginosis

Clue cell = epithelial cell covered in bacteria

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63
Q

Management of bacterial vaginosis

A

Metronidazole 2g single dose

Or as a gel

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64
Q

Problems with bacterial vaginosis in pregnancy

A

In 1st T can –> second trimester miscarriages or preterm labour
Tx with metronidazole

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65
Q

Which STI is a gram -ve diplococcus

A

Neisseria gonorrhoea

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66
Q

Symptoms of gonorrhoea

A 
Asymptomatic 
Increased vaginal discharge
Abdo / pelivic pain
Dysuria
Urethral discharge 
Proctitis / rectal bleeding 
Cervical bleeding on contact
Cervical excitation
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67
Q

Causes of cervical excitation

A

Ectopic pregnancy
PID
gonorrhoea

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68
Q

Treatment of gonorrhoea

A

Cephalosporins

- cefixime oral 400mg single dose
- cefriaxinine IM 250mg single dose
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69
Q

Which STI is an obligate intracellular pathogen

A

Chlamydia

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70
Q

Symptoms / signs of chlamydia infection

A 
Asymptomatic 
Vaginal discharge 
Lower abdo pain
Intermenstrual bleeding
Cervical discharge 
Post-coital (contact) bleeding
Dysuria 
Urethral discharge
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71
Q

Complications of chlamydia

A 
PID
Fitz-Hugh-Curtis syndrome =peri-hepatitis
Neonatal conjunctivitis 
Neonatal pneumonia
Adult conjunctivitis
Reiters syndrome = reactive arthritis
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72
Q

Treatment of chlamydia

A

Azithromycin 1g orally single dose (safe in pregnancy)

Doxycycline 100mg oral BD 7d

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73
Q

What is PID

A

Inflammation and infection arising from endocervix
Leading to endometritis, salpingitis, oophoritis and pelvic peritonitis.
Often due to chalmydia, gonorrhoea or BV

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74
Q

Symptoms / signs of PID

A 
Abdo / pelvic pain
Dyspareunia
Pyrexia >38
Heavy bleeding
Intermenstrual bleeding
Pelvic tenderness and cervical excitation on examination
Tubal damage
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75
Q

Outpatient treatment of PID

A

Ofloxacin oral 400mg BD 14d

AND metronidazole 400mg BD 14d

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76
Q

When is hospitalisation indicated for PID

A 
Severe infection
Adnexal mass ? Abscess
Sepsis
Poor response to tx
Severe pain requiring strong analgesics
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77
Q

Symptoms of herpes simplex

A

Painful vesicles
Ulcerations
Urine retention

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78
Q

Treatment of herpes simplex

A

Acyclovir 200mg 5xd

Analgesics

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79
Q

What virus causes genital warts

A

HPV 6 + 11

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80
Q

Treatment of genital warts

A

Podophyllin - local application 2x/wk
Surgical excision
Laser
Cryotherapy

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81
Q

What causes Syphillis

A

Treponema pallidum

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82
Q

Symptoms of primary Syphillis

A

Painless ulcer on vulva / cervix

Englarged groin / inguinal lymph nodes

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83
Q

Symptoms of secondary Syphillis

A

Maculopapular rash on palms and soles

Mucous membrane ulcer

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84
Q

Treatment of Syphillis

A

Procaine Penicillin I.M. daily 12d

Benzathine penicillin IM 2x 7 days apart

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85
Q

Symptoms of generalised Syphillis

A

Lymphadenopathy

Arthritis

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86
Q

Symptoms of neuro Syphillis

A

Meningitis
Stroke
Tabes dorsalis

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87
Q

Symptoms of congenital Syphillis

A

Intrauterine death
Interstitial keratitis
VIII nerve deafness
Abnormal teeth

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88
Q

Symptoms of genital TB

A

Amenorrhoea
Infertility
Acute / chronic pelvic pain
Frozen pelvis due to adhesions

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89
Q

What does haemophilus ducreyi cause

A

Chancroid

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90
Q

Symptoms of Chancroid

A

Painful shallow multiple ulcers

Regional lymphadenopathy + suppuration

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91
Q

What causes granuloma inguinale

A

Klebsiella granulomatosis

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92
Q

Failure rate of COCP per 100 women years

A

0.1-1 %

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93
Q

Failure rate of POP per 100 women years

A

1-3%

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94
Q

Failure rate of mirena per 100 women years

A

0.5%

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95
Q

Failure rate of depo prova per 100 women years

A

0.1-2%

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96
Q

Failure rate of condom per 100 women years

A

2-5%

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97
Q

Mechanism of action of COCP

A

Inhibition of ovulation
Atrophic endometrium
Thickened cervical mucus

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98
Q

Absolute CI to COCP use

A 
15 cigarettes / day
Hypertension >160 / 100
Hx of DVT / PE / stroke 
Major surgery + prolonged immobilisation
IHD / valve disease
Migraine with aura 
Migraine without aura >35 yo
Current breast cancer
Diabetes >20 yrs
Viral hepatitis / cirrhosis / liver tumours
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99
Q

SE of COCP

A 
Low mood
Mood swings
Headache 
Loss of libido
Nausea
Weight gain
Bloatedness
Breakthrough bleeding
Vaginal discharge 
Breast pain
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100
Q

Benefits of COCP

A 
Lighter less painful periods 
Regular bleeds
Improved pre-menstrual syndrome
Reduced risk of PID
Protect against ovarian and endometrial cancer
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101
Q

Mechanism of action of progesterone methods

A

Thickened cervical mucus

Thin endometrium

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102
Q

Common SE of progesterone only methods

A

Irregular / absent menstrual bleeding
Simple ovarian cysts
Breast tenderness
Acne

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103
Q

Risk of depo provera

A

Loss of bone mineral density
Weight gain (2-3kg in 1st yr)
Delay in return of fertility
Irregular / absent menstruation

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104
Q

Mechanism of action of copper IUD

A

Toxic to egg and sperm

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105
Q

SE of copper IUD

A

Heavier periods
Increased menstrual pain
Increased spotting

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106
Q

Duration of action of depo, implant, mirena, copper coil

A

Depo = 12 weeks
Implant = 3 years
Mirena = 5 years
Copper coil = 10 years

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107
Q

CI to intrauterine contraception

A 
Current STI
PID
malignant trophoblastic disease
Unexplained vaginal bleeding
Endometrial cancer
Cervical cancer
Malformation of uterus 
Copper allergy
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108
Q

Techniques to calculate the fertile period

A

Change in basal body temp
Change in cervical mucus
Track cycle days
Combination of above

109
Q

Types of emergency contraception

A

Levonelle
EllaOne
Copper IUD

110
Q

Early medical termination - drugs used + gestation

A

Mifepristone oral + gameprost pessary

4-9weeks

111
Q

Later medical termination - drugs used + gestation +opiates

12-24weeks

A

Mifepristone oral + gameprost pessary every 3-6 hours

112
Q

surgical termination - technique used + gestation

A

Suction 4-6 weeks
Suction under GA 6-14 weeks
Dilation and evacuation 12-24weeks

113
Q

Complications of termination

A

Incomplete abortion
Infection / tubal damage
Uterine perforation / cervical trauma
Psychological

114
Q

Factors decreasing fertility

A 
Increasing age
Smoking
Less frequent sex
Alcohol
Obesity
NSAIDs
Chemotherapy
115
Q

Presentation of ectopic pregnancy

A

Abdo pain
Vaginal bleeding
+ve pregnancy test
Cervical excitation

116
Q

Investigation of ectopic pregnancy

A 
obs - BP, HR, RR, temp
Hb
Group + save
Beta-HCG
TVUSS
117
Q

Management of ectopic pregnancy

A

IM methotrexate

laparoscopy - salpingectomy / salpingotomy

118
Q

Define threatened miscarriage

A

Vaginal bleeding

Os closed

119
Q

Define inevitable miscarriage

A

Vaginal bleeding

Os open

120
Q

Define incomplete miscarriage

A

Vaginal bleeding

Os open, products of conception in os

121
Q

Define complete miscarriage

A

Pain and bleeding resolved
So closed
No retained products on USS

122
Q

Define missed miscarriage

A

Fetal pole present on USS - no heart beat
Or Gestational sac present but no fetal pole

No pain or bleeding

123
Q

Management of miscarriage

A

Expectant
Medical - oral misoprostal + gameprost pessary
Surgical - ERPC

124
Q

Define cervical ectropion

A

Benign condition
Columnar epithelium on vaginal aspect of cervix.
Transforms to squamous epithelium

125
Q

Define nabothian follicle

A

Mucus filled cyst within the ectocervix - not significant - no tx needed

126
Q

Causes of cervical ectropion

A

Puberty
Pill
Pregnancy

127
Q

Causes of cervical stenosis

A

Usually iatrogenic
Cervical cone biopsy / LLETZ
Endometrial ablation devices

128
Q

What is asherman’s syndrome

A

Endometrial cavity fibrosis and adhesion

129
Q

What is a uterine fibroid

A

Benign tumour of uterine smooth muscle = leiomyoma

130
Q

Risk factors for uterine fibroids

A

Nulliparity
Obesity
Family history
African origin

131
Q

Symptoms of uterine fibroids

A

Pelvic mass
Menstrual disturbance
Pressure symptoms - urinary frequency

132
Q

Management of fibroids

A 
Watch and wait if asymptomatic 
Medical tx for heavy menstrual bleeding
Uterine artery embolisation
Myomectomy
Hysterectomy
133
Q

Cell types of endo and ecto cervix

A 
Endocervix = canal = columnar glandular epithelium
Ectocervix = external = squamous epithelium
134
Q

Symptoms and causes of acute cervicitis

A 
Irritation, mucus/pus discharge 
Dyspaerunia
Post coital bleeding
Inter-menstrual bleeding
STIs
135
Q

Cell type of cervical polyp

A

Endocervical = columnar (glandular) epithelium

136
Q

symptoms of cervical polyp

A

Asymptomatic
Intermenstrual bleeding
Post coital bleeding
Rarely >1cm

137
Q

What is cervical dysplasia

A

Cervical intraepithelial neoplasia.

Atypical cells in the squamous epithelium

138
Q

If untreated what % of CIN develop cancer over 10 years

A

1/3 with CIN II or III

CIN Commonly regresses - can progress to CIN II or III

139
Q

What age is CIN most common

A

90% <45yo

Peak incidence 25-29

140
Q

Aetiology of cervical cancers

A

HPV 16, 18, 31, and 33 most common.
HPV vaccine is for 16 and 18
Oral contraceptives (all COC, POP, depot)
Smoking

141
Q

Biggest risk factor for the development of cervical cancer

A

Non-attendance for cervical screening

142
Q

Who is invited for cervical screening + how often

A

25-64
Every 3 years until 50 then 5 yearly until 65.
Screen >65s if abnormal result or no screening since age 50
If abnormal screen again in 6m 2x more then return to routine recall.
Post-colposcopy yearly screening for 10 years

143
Q

Describe colposcopy

A

Speculum ex + microscope magnification 10-20x
Acetic acid stain + iodine
+ biopsy

144
Q

What is a LLETZ procedure + what’s it for

A

Large loop excision of the transformation zone

For CIN II or III

145
Q

Possible complications of LLETZ

A

Haemorrhage
Cervical stenosis
Slight increased risk of preterm delivery

146
Q

Peak incidence of cervical carcinoma

A

2 peaks -30s and 80s

147
Q

Types of cervical carcinoma

A

90% squamous malignancies

10% adenocarcinomas (worse prognosis)

148
Q

What organism causes chancroid

A

Hawmophilus ducreyi

149
Q

Presentation of chancroid (STI)

A

Ulcerative
Small papule, ulcerates
Forms a single or multiple painful superficial ulcers
Inflammation can lead to phimosis
Enlargement and suppuration of inguinal LN may occur –> bubo formation

150
Q

Features of acute PID

A

Pelvic pain
Pyrexia
Cervical excitation
Adnexal tenderness

151
Q

Presentation of bacterial vaginosis

A

Creamy-grey discharge
Fishy odour
No itch

152
Q

What do clue cells on microscopy indicate

A

Bacterial vaginosis

153
Q

What is Stress incontinence

A

Involuntary leakage of urine on effort / exertion /sneezing / coughing.
Due to an incompetent sphincter.
May be associated with genitourinary prolapse.

154
Q

What is Urge incontinence

A

Involuntary urine leakage
Accompanied by/ immediately preceded by urgency.
Due to detrusor instability or hyperreflexia leading to involuntary detrusor contraction.

155
Q

What is Mixed incontinence

A

Involuntary leakage of urine associated with urgency and exertion/effort/sneezing/ coughing.

156
Q

What is Overactive bladder syndrome (OAB)

A

Urgency with or without urge incontinence
+ usually frequency and nocturia.
+/- Incontinence

157
Q

What is Overflow incontinence

A

Due to chronic bladder outflow obstruction.
Often due to prostate disease in M.
Can be due to a neurogenic bladder.

158
Q

What is True incontinence

A

continuous urine leakage

May be due to a ureto/urethro/bladder-vaginal fistula

159
Q

Treatment of PCOS

A

COCP

Metformin

160
Q

What is tranexamic acid

A

Anti-fibrinolytic

161
Q

Cause of a single painless ulcer on genital area

A

Primary Syphilis

162
Q

Multiple painless maculopapular ulcers with lymphadenopathy following a primary genital answer is due to what

A

Secondary syphilis

163
Q

What is 3rd degree uterine prolapse?

A

Uterine descent with cervical protrusion beyond the introitus

164
Q

Is 3rd degree uterine prolapse painful?

A

No. Unless ulcerated

165
Q

Does 3rd degree uterine prolapse cause difficulty defecating?

A

Yes it can - by pressure on the anterior wall of the rectum.

166
Q

Can 3rd degree uterine prolapse cause urinary incontinence?

A

Yes.

Or retention

167
Q

Possible symptoms of endometriosis

A 
Ovulation pain
Mid cycle lower abdominal pain
Heavy menstruation
Dysmenorrhoea 
Dysparunia
Dysuria 
Haematuria
168
Q

What is primary vulvodynia?

A

Chronic vulval pain of more than 3 months dating from 1st sexual experience or tampon use

169
Q

What is secondary vulvodynia?

A

Chronic vulval pain of more than 3 months developing after previous pain free sexual intercourse

170
Q

Associations with vulvodynia

A

Change in sexual partner
Thrush
STI
Depression

171
Q

Most common cause of vaginal discharge

A

Bacterial vaginosis

172
Q

Effect of bacterial vaginosis (BV) on vaginal PH

A

Loss of normal vaginal acidity.

PH increases to greater than 4.5.

173
Q

Symptoms of BV

A

50% are asymptomatic.

Fishy-smelling vaginal discharge

174
Q

Non infective causes of abnormal vaginal discharge?

A 
Retained foreign body, 
Iflammation due to allergy or irritation, 
Tumours, 
Atrophic vaginitis,
Cervical ectopy,
Cervical polyps
175
Q

Drugs for heavy menstrual bleeding

A 
Mefenamic acid
Tranexamic acid
Norethisterone day 15 or 19 - 26
Levornagesterel IUD
Danazol
176
Q

How frequent should HIV +Ve women have cervical smears?

A

Yearly.

regardless of CD4 count or VL

177
Q

What is the recommended frequency of cervical smears for women aged 25-49?

A

3 yearly

In England

178
Q

What is the recommended frequency of cervical smears for women aged 50-64?

A

5 yearly

In England

179
Q

What is Ashermans syndrome?

A

Interuterine adhesions ranging from complete obliteration to minimal adhesions

180
Q

What is Sheehan syndrome

A

Intrapartum pituitary haemorrhage causing pituitary necrosis. Leads to hypopituitarism

181
Q

Does smoking affect the menopause?

A

Yes, makes it earlier

182
Q

Define postmenopausal bleeding

A

PV bleeding occurring at least 12 months after the cessation of menstruation

183
Q

Causes of postmenopausal bleeding include

A 
Vulvovaginal atrophy 
Endometrial carcinoma
Endometrial hyperplasia
Cervical cancer
Ovarian cancer
Liver cirrhosis
184
Q

A retroverted uterus may be associated with what symptoms

A

Backache

dyspareunia

185
Q

Characteristics of lichen sclerosis

A

Thickened skin and accentuated markings of the vulva

Itching and pain

186
Q

What is the malignant potential of lichen sclerosis in %

A

Potential of squamous cell carcinoma of the vulva in 2 - 5%

187
Q

Treatment of lichen sclerosis

A

Topical steroids
Bland emollient
Avoid irritants, heat and allergens

188
Q

What may koilocites on a cervical smear suggest

A

Human papilloma virus infection

189
Q

Possible presentation of antiphospholipid syndrome

A 
Recurrent miscarriage
Arterial or venous thrombosis
Livedo reticularis rash
Stroke
Adrenal haemorrhage
Migraine
Myelitis
Myocardial infarction
Multi-infarct dementia
190
Q

Antibodies found in antiphospholipid syndrome

A

anti-phospholipid antibodies

Anti-cardiolipin antibodies

191
Q

What is premenstrual syndrome

A

Physical and/or psychological symptoms affecting some women up to 10 days prior to menstruation. Acne, breast tenderness, bloating, fatigue, nervousness, irritability, emotional disturbance, headache, mood changes.
Usually resolves with or after menstruation .

192
Q

When and how often is cervical smear screening offered in England

A

25-49 3 yearly

49-64 5 yearly

193
Q

When should women be referred to colposcopy

A

3 consecutive inadequate smears
3 abnormal smears of any grade within 10 years
1 moderate or severe dyskaryosis
1 borderline or mild dyskaryosis with +ve HR HPV
1 smear with possible invasion / glandular neoplasia

194
Q

What happens to CIN on colposcopy when acetic acid and iodine are applied

A

Aceto-white change

Failure of iodine staining

195
Q

Symptoms of cervical ectropion

A

Asymptomatic
Mucoid discharge
PCB

196
Q

Causes of dysparunia

A 
Vulvovaginitis (esp thichomoniasis and candida)
Vaginal cysts
Infected bartholins gland
Post menopause / vaginal atrophy
Congenitally small ostium / thick hymen 
Deep retroverted uterus 
Chronic pelvic infection
Endometriosis
Adenomyosis
Pelvic tumours
Ectopic pregnancy
197
Q

What kind of organism is trichomonas vaginalis

A

Flagellated protozoan

198
Q

How is trichomonas vaginalis best diagnosed?

A

Swab from the posterior fornix of the vagina observed under a microscope as a wet prep.
Send NAATs

199
Q

Symptoms of trichomonas vaginalis

A

Malodorous frothy discharge

200
Q

What STI is a flagellated protozoan?

A

trichomonas vaginalis

201
Q

What STI is an intercellular diploccocus

A

Neisseria gonorrhoea

202
Q

What type of organism is neisseria gonorrhoea

A

Gram negative intracellular diplococcus

203
Q

What is phthiriasis pubis

A

Pubic lice

204
Q

How is phthiriasis diagnosed?

A

Pubic lice - Can be seen by the naked eye.

205
Q

Treatment of phthiriasis

A

alathion lotion or permethrin cream.
All body hair should be treated.
All bedding should be washed at high temperatures.
Sexual partners need treatment.

206
Q

How is Candida albicans diagnosed?

A

Culture

Or presence of hyphae, pseudo hyphae and spores on microscopy.

207
Q

Is Candida albicans sexually transmitted?

208
Q

What is the name of the pox virus?

A

Molluscum contagiosum

209
Q

what is Molluscum contagiosum caused by?

A

A poxvirus

210
Q

appearance of Molluscum contagiosum

A

small, raised, pink lesions with a central punctum.
Occasionally itch or sore.
Single or in groups

211
Q

How is molluscum contagiosum transmitted?

A

Skin to skin contact

212
Q

Can herpes cause an asymptomatic infection?

213
Q

Is genital herpes in pregnancy a risk to the fetus?

A

Primary herpes in the 3rd trimester can be transmitted to the fetus at birth

214
Q

Diagnostic criteria of bacterial vaginosis

A

Amsel criteria (3/4 of):

1) Thin, white, yellow, homogeneous discharge
2) Clue cells on microscopy
3) pH of vaginal fluid >4.5
4) Release of a fishy odor on adding alkali—10% potassium hydroxide solution.

215
Q

World wide incidence of sexual assault

A

1 in 5 women.

Often not reported

216
Q

What genital infection is a diploid fungus?

A

Candida albicans

217
Q

Symptoms of Candida albicans

A 
Vulval itching / soreness
Thick curd like discharge 
Dysuria
Dyspareunia
Vulval oedema
Vulval excoriation/erythema
218
Q

Predisposing factors for genital thrush

A 
Pregnancy
COCP
Immunosuppression 
Broad spectrum antibiotics
DM
HRT
HIV
219
Q

Effect of thrush ion on pregnancy

A

No adverse effect in pregnancy.
Can be treated with topical imidazoles.
Cannot have oral imidazoles.

220
Q

What organism is commonly associated with PID in association with an IUCD?

A

Actinomyces Israelii

221
Q

Management of bacterial vaginosis

A

No treatment or Metronidazole (or clindamycin gel)

222
Q

% of F with BV who are asymptomatic

223
Q

Treatment of BV

And treatment in pregnancy

A

Metronidazole 400mg BD 5-7/7 (avoid STAT dose if possible)

Clindamycin gel pregnancy

224
Q

risks of surgical termination of pregnancy

A 
Haemorrhage
Cervical trauma 
Placental perforation
Endometritis
Ashermanns syndrome 
Tubal blockage 
regret / psychological effect
225
Q

Most common cell type of endometrial cancer

A

adenocarcinomas

226
Q

Risk factors for endometrial cancer

A 
Nulliparity
Late menopause
early menarche
Oestrogen treatment 
Obesity
Diabetes
Lack of exercise
Increased age
PCOS / anovulation
High fat diet
Endometrial hyperplasia
Familial history 
tamoxifen
Personal hx of breast or ovarian cancer
Previous pelvic irradiation
?tibolone
227
Q

Progression from normal cervical epithelium to invasive carcinoma takes at least how long?

A

On average 15 years

228
Q

In what cancers is alpha-feto protein raised

A 
Ovary 
Testis
Liver
Pancreas 
Lung 
Stomach 
Colon
229
Q

Common symptoms of ovarian cancer

A

Abdominal distension / blaoting
Abdominal discomfort / pain
Ascites

230
Q

What is Ca 125 a marker for?

A

Ovarian cancer

231
Q

Presentation of endometrial carcinoma

A

Postmenopausal bleeding

Premenopausal menstrual irregularity

232
Q

When CIN is found in the deeper layers of the cervical epithelium (lower 1/3) what grade of CIN would this be?

A

CIN 1

Undifferentiated cells confined to lower 1/3

233
Q

When CIN is found in the lower 2/3 of the cervical epithelium what grade of CIN would this be?

A

CIN 2

More marked nuclear abnormalities than CIN 1

234
Q

When CIN is found throughout the thickness of the cervical epithelium what grade of CIN would this be?

235
Q

Which HPV viruses are most associated with cervical cancer

A

16 and 18 (33, 31)

236
Q

Risk factors for female genital tract neoplasia

A 
Increased number of sexual partners
Persistent HPV infection
Immune compromise
Cigarette smoking
Low socioeconomic status
Prolonged use of the OCP 
Higher number of pregnancies
237
Q

What are the most common symptoms of cervical cancer

A

Abnormal vaginal bleeding / discharge

Discomfort during intercourse

238
Q

How is high dose brachytherapy for cervical cancer delivered?

A

Applicators are put in the cervix and connected to an afterloading machine which delivers radiation at a high dose rate for a few minutes.
Often repeated several times, a few days apart, on an outpatient basis

239
Q

What is topotecan used to treat

A

Advanced cervical cancer
Ovarian cancer
Small cell lung cancer

240
Q

How does topotecan chemotherapy work

A

Prevents DNA replication in cancer cells by inhibiting the enzyme topoisomerase I.

241
Q

What is DySIS?

A

digital video colposcope using dynamic spectral imaging to evaluate the blanching effect of applying acetic acid to the epithelium. It measures the rate, extent and duration of the acetowhitening.

242
Q

What is the annual incidence of cervical cancer in the UK

A

The annual incidence of cervical cancer in the UK is estimated to be 9.7 per 100,000 population.

243
Q

What is the annual mortality rate for cervical cancer in the UK?

A

The annual mortality rate for cervical cancer in the UK is 3.9 per 100,000 population (2001)

244
Q

How is liquid based cytology carried out

A

Samples collected using a brush.
The head is rinsed / broken off in a vial of preservative.
Samples mixed to disperse the cells.
Cellular debris/ blood/ mucus is removed.
A thin layer of cervical cells put on a slide and stained.

245
Q

What does a Radical hysterectomy involve

A

Surgical removal of the uterus, supporting ligaments, upper vagina and pelvic lymph nodes +/- para-aortic lymph nodes.

246
Q

What approaches are possible for a radical hysterectomy

A

standard approach = abdominal incision. Laparoscopic radical hysterectomy

247
Q

What is the extent of stage 1 cervical cancer

A

stage I cervical cancer is confined to the cervix

248
Q

What is the extent of stage 2 cervical cancer

A

Stage IIA - tumour invades the cervix with endocervical glandular involvement only.
Stage IIB - Tumour has spread upward into tissues around the cervix but not into the pelvic wall.

249
Q

Characteristics of stress incontinence

A

Leakage of urine when abdominal pressure raised - coughing, sneezing, lifting.

250
Q

Cause of stress incontinence

A

Weak pelvic floor muscles causing impaired urethral support

251
Q

Characteristic of urge incontinence

A

Involuntary urinary voiding following an episode of desiring to pass urine.

252
Q

Mechanism of urge incontinence

A

Uninhibited bladder contraction - detrusor activity

253
Q

Possible causes of urge incontinence

A

Spinal stenosis
Stroke
Neurological disease

254
Q

When is treatment of vaginal prolapse with a ring pessary indicated

A

Temporary measure
Women wishing to become pregnant
Patients declining / postponing operative treatment

255
Q

Investigations for a 30-year-old F with a amenorrhoea and galactorrhoea

A 
Urine pregnancy test
Serum prolactin
Serum oestradiol
Serum LH
Serum FSH

MRI/CT head

256
Q

What percentage of circulating testosterone is derived from conversion of androstenedione

257
Q

What percentage of circulating testosterone is free?

A

1%

Remainder bound to sex hormone binding globulin

258
Q

By what mechanisms does the COCP cause increase risk of thrombosis

A 
Increased platelet count
Increased platelet adhesiveness
Decreased antithrombins
Increased clotting factors
Increased prothrombin
Increased fibrinogen
259
Q

Mechanism of action of the levornogestrel emergency contraceptive pill

A

Delay ovulation by inhibiting the LH surge
No evidence of impeding implantation.
May interfere with sperm function

260
Q

Mechanism of action of the emergency IUCD

A

Prevents implantation

toxic to egg and sperm

261
Q

What are the 3 phases of the menstrual cycle

A
  1. Follicular (pre-proliferative)
  2. Ovulation
  3. Luteal phase
262
Q

What happens to oestrogen levels in the first 14 days of the cycle

A

Rise and peak on day 14

263
Q

Average menstrual blood loss

264
Q

Mechanism of action of progesterone only methods

A

Thicken cervical mucus
Lesser effect on tubal motility and endometrium
DMPA / desogestrel / implant suppresses ovulation

265
Q

Ideal use failure rate of POP

266
Q

Ideal use failure rate of DMPA

267
Q

Ideal use failure rate of IUS

268
Q

Disadvantages of progesterone only methods

A

Irregular bleeding
hormone side effects
DMPA delays return of fertility
DMPA can cause weight gain

MBBS / MBChB finals (25 decks)

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