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CP2 OBGYN > Gynae p3 > Flashcards

Gynae p3 Flashcards

1
Q

Def Amenorrhoea

A

Absence of menstruation

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2
Q

What is primary amenorrhoea

A

When menstuation hasn’t started by age 16

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3
Q

What is secondary amenorrhoea

A

Previous normal menstruation ceases for 3 months or more

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4
Q

Oligomenorrhoea

A

Menstruation occurs ev 35 dyas –> 6 m

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5
Q

Physiological causes of amenorrhoea (3)

A

Pregnancy
After menopause
During lactation

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6
Q

Primary pathological causes of amenorrhoea

A

Congenital abnormalities

Or acquired disorders

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7
Q

Secondary pathological causes of Amenorrhoea (3)

A

Premature menopause
PCOS
Hyperprolactinaemia

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8
Q

Drugs causing amenorrhoea (3)

A

Progestogens
GnRH analogues
Antipsychotics

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9
Q

hypothalamic causes of ameorrhoea

A 
Hypothalamic hypogonadism (anorexia/XS exercise)
Tumours
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10
Q

Tx of hypothalamic causes of amenorrhoea

A

Supportive

replace O if req - COCP/HRT

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11
Q

Pituitary causes of amenorrhoea

A

Hyperprolactinemia - hyperplasia

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12
Q

Mx pit causes of amenorrhoea (2)

A

Cabergoline

Surgery

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13
Q

outflow tract issues - causes of amenorrhoea - congenital (2)

A

Imperforate hymen

Transverse vaginal septum

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14
Q

Outflow tract issues - causes of amenorrhoea - acquired (2)

A

Cervical stenosis

Ashermans

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15
Q

Tx outflow tract issues –> amenorrhoea

A

Surg

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16
Q

Def menopause

A

Permanent cessation of menstruation from loss of ovarian follicular activity

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17
Q

Median age menopause

A

51

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18
Q

When is natural menopause recognised

A

After >12 months consecutively of amenorrhoea

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19
Q

What is perimenopause

A

Time beginning w/ 1sat features of approaching menopause + ends 12m after LMP

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20
Q

Def premature menopause

A

Menopause occuring before the age of 40

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21
Q

Vasomotor Sx menopause

A

night sweats
sleep disturbance
hot flushes

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22
Q

Tx vasomotor Sx menopause

A

Clonidine

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23
Q

Psychological Sx menopause (3)

A

Memory problems
Loss of mental sharpness
Easier to lose temper

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24
Q

Urogenital Sx menopause (43)

A

Vaginal atrophy/urinary problems
Loss of oestrogen receptors on urethra/bladder –> destrusor instability + incontinence
Atrophy –> itching, burning, dryness

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25
Q

Other Sx of menopause

A

OP

Sexual problems

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26
Q

Ix menopause (2)

A

FSH levels

AMH - antimullerian hormone = low levels in ov failure

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27
Q

What are the 3 main types of HRT ?

A

Combined - O+P

Oestrogen only

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28
Q

Who can have oestrogen only HRT

A

Women who have had hysterectomy

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29
Q

What is Tibolone

A

Testosterone derivative for F who desire amenorrhoea = Tx vasomotor, psycho + libido problems

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30
Q

What are SERM’s

A

Selective oestrogen receptor modulators - clomiphene, raloxifene

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31
Q

Mode of action SERMs

A

Make ovaries ovulate

Dont fit on brain/breast/EM receptors :)

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32
Q

Negative of SERMS

A

expensive

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33
Q

+ves of Oral HRT (2)

A

Cheap

Effective

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34
Q

-ves of oral HRT (4)

A

Partial metabolism in gut
Can cause indigestion problems
Peaks + troughs in plasma levels
Incr risk VTE

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35
Q

+ves of transdermal HRT patch (2)

A

Avoids liver

Continuous absorption

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36
Q

-ves transdermal HRT patch (2)

A

Expensive

skin reactions

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37
Q

+ves of TO gel HRT

A

Continuous absorption

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38
Q

-ves of TO gel HRT (4)

A

O prep only
Messy
Incr risk CA
Expensive

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39
Q

+ves of implant HRT

A

Only have to replace every 6 months

40
Q

-ves of implant HRT (3)

A

Cant be removed
Still req P
Problems w/ oestrogen sensitivity

41
Q

+ves of vaginal cream HRT (2)

A

Specific local effectr

Great for urogenital Sx

42
Q

-ves vaginal cream HRT (2)

A

O only

LT EM stim b/c systemic absorption

43
Q

What is cyclical/sequential HRT

A

Take O every day + P only last 14 days menstrual cycle

Will still have period

44
Q

Who is cyclical/sequential hRT for

A

F on HRT who have menopausal Sx but still have periods

45
Q

What is continuous combined HRT

A

O+P everyday without a break

Or O everyday

46
Q

Who has continuous combined HRT

A

Menopausal F who have been >2 yinto the mennopause

47
Q

Use of mirena in HRT

A

for O only as an adjunct

Have to change every 4 years not 5

48
Q

Things to know when coming off HRT

A

Staggered approach b/c withdrawal Sx

Aim = to get off HRT at age of menopause

49
Q

When must youi STOP HRT

A

If any Sx/signs of breast cancer

50
Q

Risks HRT (4)

A

Br cancer
EM cancer
VTE
CVD?

51
Q

C/I HRT *7)

A 
EM cancer 
Breast cancer 
Undiagnosed vaginal bleeding 
Undiagnosed breast lump 
Suspected pregnancy 
Liver disease w/ imp LFT
Prev VTE assoc w/ COCP, preg, O replacement
52
Q

Non-hormonal alts to HRT (2)

A

Clonidine - esp good for hot flushes/ night sweats

SSRIs/SSNI’s

53
Q

WHat is a Bartholin’s abscess

A

Abscess of gland towards post fourchette

54
Q

Pathophysiology Bartholin’s abscess

A

Openings at vaginal orifiece secrete mucus to lubricate vaginal
Builf up of f mucus –> blocked gland –> if un Tx –> cyst –> abscess

55
Q

Infective organisms Bartholin’s (3)

A

E coli
MRSA
STIS

56
Q

RF Bartholins ((3)

A

Prev Bartholins
Sexally active
Hx of vulval surgery

57
Q

PS Bartholins cyst

A

Small = asymp
Vulvar pain
Superficial dyspareunia

58
Q

PS Bartholins abcsess (2)

A

Acute onset pain

difficulty passing urine

59
Q

DDx Bartholins (3)

A

Bartholins gland carcinoma
Bartholins benign tumour
Lipoma/leiomyoma

60
Q

Ix Bartholins

A

often clinical
Swab
>40 - biopsy to excl carcinoma

61
Q

Mx Bartholins

A 
Word catheter 
Or marsupialisation (vertical incision)
62
Q

Physiological causes of vaginal discharge (4)

A

Vestibular gland secretions
vaginal transudate
cervical mucus
Residual menstrual fluid

63
Q

Hx q vaginal discharge

A 
Timing of onset
Colour 
Odor 
Blood 
Irritation 
Assoc Sx 
Prev pessary ring
Prev hysterectomy 
Prev obstructed labour 
DM? 
Methods of contraception 
Recent ABx
64
Q

STIs causing discharge (3)

A

Chlamydia
TV
N gonorrhoea

65
Q

non-Sexually transmitted Infections causing discharge (2)

A

BV

Candida

66
Q

Inflammator causes of discharge (3)

A

Allergy to soaps
Atrophic changes
Post op granulation tissues

67
Q

Malignancy causes of discharge (3)

A

Vulval carcinoma
Cervical carcinoma
Uterine carcinoma

68
Q

FB causes of discharge (2)

A

Retained condom/tampon

Ring pessary

69
Q

Candidia discharge

A

Thick itchy white cottage cheese

70
Q

BV discharge

A

Grey, fish smelling

71
Q

O/E - Ix discharge

A

Abdo palp
Speculum
Bimanual palp

72
Q

Which discharge causes do you need to swab for?

A

candida
TV
Chlamydia
Gonorrhoea

73
Q

Which sicharge cause do you need to MSU for

A

Infective causes

74
Q

Other Ix discharge

A

Cervical cytology
EM sampling/hysteroscopy
Pelvic USS
Laparoscopy

75
Q

Def pruritis vulvae

A

Itching or irritation of the vulva

76
Q

What 4 groups of conditions cause pruritis vulvae?

A

Vulval dystrophy
Neoplastic
Derm
Infection

77
Q

O/E pruritis vulvae

A 
Derm? 
Signs chronic renal and liver disease 
Examine vulva, urethral meatus, perinanal region 
VE/Speculum 
Coloscopy
78
Q

Features on examination suggestive of vulval infection (3)

A

Generalised vulvitis
Vaginal discharge
Genital warts/herpes

79
Q

Features o/e suggestive of vulval dystrophies (4)

A

Labial fusions
Adhesions
Stenosis of introitus
Leucoplakia

80
Q

Ix pruritis vulvae

A

LFT/RFT/GTT/urinalysis
Bacterial swabs
STI screen
Histological (punch biopsies)

81
Q

Causes of endometritis (4)

A

Instrumentation of uterus
Complication of pregnancy
Infection - STIs
E.coli/BV/Staph

82
Q

PS endometritis (3)

A

Persistent/heavy vaginal bleeding
tender uterus
open cervical os

83
Q

Ix endometritis

A

Swabs

FBC

84
Q

Mx endometritis

A

BS ABx

US?

85
Q

RF PID (4)

A

Young F
Poverty
Sexually active
Nulliparous

86
Q

Protective factors PID (2)

A

Mirena

OCP

87
Q

PS PID

A

Mostly asymp
PS later w/ subfertility/menstrual problems
Deep dyspaerunia + abnorm bleeding
Bilateral lower abdo pain

88
Q

O/E PID

A

Severe incr HR, fever, lower abdo guarding

Cervical excitation + tender adnexae

89
Q

DDx PID (3)

A

Appendicitis
Ovarian cyst
Ectopic

90
Q

Ix PID

A

Endocervical swabs
Bloods - cultures, FBC, WCC, CRP
Pelvic USS - excl abscess/cysts
Laparoscopy + fimbria biopsy = gold standard

91
Q

Mx PID

A

Analgesia
IV ABx
Review in 24 hr - if no improvement –> laparoscopy

92
Q

Compications PID

A

Abscess
Subfertility
Ectopic pregnancy

93
Q

Cause of chronic PID

A

Persisting infection due to poor Tx PID

94
Q

Sx chronic PID (6)

A 
Chronic pelvic pain 
Dysmenorrhoea 
Deep dyspareunia 
Heavy irreg menstruation 
Chronic discharge 
Subfertility
95
Q

O/E - chronic PID

A

Abdo + adenxal tenderness

Fixed retroverted uterus

96
Q

Ix chronic PID

A

TV USS

Laparoscopy

97
Q

Mx chronic PID

A

Analgesia
ABx
Adhesiolysis
Salpingectomy

CP2 OBGYN (21 decks)

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