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My Phase 3a cards > Gynae Peer Teaching > Flashcards

Gynae Peer Teaching Flashcards

1
Q

When is the first day of the menstrual cycle?

A

The first day of menstruation

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2
Q

What happens to the endometrium during menstruation?

A

The spiral arteries vasoconstrict
Necrosis/shedding of the endometrium
Contraction of the myometrium (causing pain)

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3
Q

What phase is between day 5-13?

A

Proliferative phase

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4
Q

What happens in the proliferative phase (day 5-13)

A

FSH rises and stimulated the follicles to mature
Follicles produce estradiol (which inhibits FSH) and the endometrium reforms
There is an LH surge

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5
Q

What phase is between 14 and 28 days?

A

Luteal phase

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6
Q

What happens in the luteal phase (14-28#0

A

The follicle becomes the corpus luteum which produces progesterone

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7
Q

What changes occur in the endometrium during the luteal phase?

A

stromal cells enlarge
glands swell
Epithelial cell vacuolation

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8
Q

What happens at the end of the luteal phase if pregnancy does not occur?

A

Corpus luteum begins to fail - causing the progesterone and estrogen levels to fall
Endometrium begins to break down

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9
Q

What is the age of normal menarche?

A

11-16 years

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10
Q

When is normal menopause?

A

Over 45 years

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11
Q

How long is the normal menstrual period?

A

Less than 8 days

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12
Q

What causes menopause?

A

Loss of ovarian follicular activity

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13
Q

When is perimenopause?

A

Starting with the first features of menopause and ending 12 months after the last period

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14
Q

When is premature menopause?

A

Before 40

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15
Q

Name 3 conditions which early menopause increases the risk of occurring.

A

Osteoporosis
Cardivascular disease
Dementia

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16
Q

What are the urogenital problems associated with menopause?

A

Vaginal atrophy
Urinary problems e.g. infection, incontinence
Dyspareunia

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17
Q

List 2 investigations for menopause and when they should be undertaken:

A

FSH between days 2-5 and is ELEVATED in menopause

Anti-mullerian hormone any day

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18
Q

Which cancer risk is increased with combined HRT and oestrogen only HRT?

A

Combined = breast cancer

Oestrogen onle = endometrial

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19
Q

Name 3 risks of HRT

A

VTE
CVS disease
gall bladder disease
(endometrial and breast cancer)

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20
Q

Give 2 causes of premature menopause

A

chemo and radiotherapy

hysterectomy

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21
Q

What would the blood tests reveal in someone going through premature menopause?

A

Low Oestrogen (<20) and high FSH >40IU

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22
Q

Treatment for premature menopause:

A

HRT
Fertility
Androgen replacement e.g. testosterone gel

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23
Q

Menorrhagia is….

A

Blood loss >80mL or blood loss that interferes with a woman’s daily quality of life

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24
Q

How to know if menstrual bleeding is more than 80mL?

A

Ask about flooding and passage of clots

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25
Q

Investigations for menorrhagia

A

Transvaginal ultrasound - assess endometrial thickness and exclude fibroid/ovarian mass

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26
Q

When is an endometrial biopsy indicated for women with menorrhagia?

A
  • endometrial thickness >10mm in premenopausal women or >4mm in postmenopausal women
  • suspected polyp
  • intermenstrual bleeding
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27
Q

What is the initial investigation of menorrhagia?

A

Pelvic bimanual examination
Menstrual charting
Anaemia
TFT, coagulopathies excluded

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28
Q

What is the first line management of menorrhagia?

A

IUS

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29
Q

What is the management of menorrhagia in women trying to conceive?

A

Tranexamic acid or NSAIDs

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30
Q

Name 2 surgical managements for menorrhagia? (George had 1)

A

Endometrial ablation

Uterine artery embolisation

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31
Q

What does tranexamic acid do?

A

It is an anti fibrinolytic that Inhibits the conversion of plasminogen to plasmin may reduce blood loss by 50%

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32
Q

If your periods have not started by age 16 this is called…

A

Primary amenorrhoea

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33
Q

If your periods have stopped for more than 6 months this is called…

A

Secondary amenorrhoea

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34
Q

If your menstrual cycle is more than 35 days for 6 months this is called…

A

Oligomenorrhoea

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35
Q

Name 4 investigations in amenorrhoea

A

Pregnancy test
FSH and LH
Prolactin (TWICE)
Total testosterone and sex-hormone binding globulin levels

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36
Q

If you suspect PCOS what is the investigation?

A

Pelvic ultrasound

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37
Q

What is secondary dysmenorrhoea?

A

Pain BEFORE onset of menstruation

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38
Q

Name some fatures associated with secondary dysmenorrhoea

A

Depp dyspareunia

Heavy and irregular menstrual flow

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39
Q

What may cause secondary dysmenorrhoea?

A

fibroids, endometriosis, ovarian tumours

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40
Q

Investigations for secondary dysmenorrhoea?

A

Pelvic ultrasound
examination
Swabs if STI risk

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41
Q

When do you have anovulatary ccycles?

A

During the early and late reproductive years

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42
Q

List 3 non malignant causes of irregular menstrual bleeding.

A

Fibroids
Uterine polyps
Adenomyosis

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43
Q

How do cervical pathologies commonly present?

A

Post coital bleeding

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44
Q

Name the ligaments which support the uterus at the cervix

A

uterosacral ligaments and cardinal ligaments

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45
Q

What is the fold of peritoneum that covers the uterus, fallopian tubes and ovaries called?

A

The broad ligament

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46
Q

Name the 3 parts of the broad ligmanent

A

Mesovarium
Mesosalpinx
Mesometrium

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47
Q

Which arteries run through the broad ligament?

A

Ovarian and uterine arteries

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48
Q

Which ligaments run through the broad ligament

A

Round ligament of the uterus
ovarian ligament
suspensory ligament of uterus

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49
Q

Name the branches from the internal iliac artery to the endometrium (UARBS)

A

internal iliac artery > uterine artery > arcuate artery > radial artery > basal artery > spinal artery

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50
Q

What is a fibroid?

A

Benign tumour of the myometrium

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51
Q

Describe the protective factors for fibroids.

A

Anything that stops periods - pregnancy, late puberty and taking the pill.
More pregnancies = less risk

52
Q

What do you see on histology of a fibroid?

A

Wholled appearance

53
Q

What is the difference between a subserosal fibroid and a submucosal fibroid?

A

Subserosal fibroids extend into the peritoneal cavity, submucosal fibroids extend into the uterus

54
Q

Subserosal fibroids may cause pressure symptoms suc as…

A

urinary frequency
hydronephrosis
infertility

55
Q

What are the consequences of fibroids during pregnancy?

A

Malpresentation, transverse lie, PPH, obstructed labour

56
Q

How would you investigate a fibroid?

A

Bimanual pelvic exam

Pelvic ultrasound

57
Q

What are some medical treatments of uterine fibroids?

A

Tranexamic acid
Ulipristal acetate
Mifepristone

58
Q

Whaat is adenomyosis?

A

Presence of endometrium in the myometrium

59
Q

What would you find on examination of someone with adenomyosis?

A

A large, tender uterus

60
Q

How is adenomyosis best diagnosed? When is it usually diagnosed?

A

Best: MRI
Usually: diagnosed on histology post hysterectomy

61
Q

Name 3 medical and 1 surgical treatment for adenomyosis.

A
  1. IUS
  2. COCP
  3. GnRH analogue (zoladex)
  4. Hysterectomy
62
Q

How is a polyp removed?

63
Q

What causes congenital uterine abnormalities?

A

Failure of fusion of the Mullerian ducts at 9 weeks gestation

64
Q

Congenital uterine abnormalities cause problems with pregnancy such as….

A

recurrent miscarriage, transverse lie, malpresentation, retained placenta

65
Q

What is the most common endometrial cancer?

A

Adenocarcinoma

66
Q

What are the risk factors for endometrial cancer?

A

Nulliparity, late menopause, unopposed oestrogen therapy and tamoxifen therapy

67
Q

What is the most common symptom of endometrial cancer? And in pre-menopausal women?

A

post-menopausal bleeding

intermenstrual bleeding

68
Q

What investigation must be performed in suspected endometrial cancer?

A

TRANSVAGINAL pelvic ultrasound to measure the thickness of the endometrium

69
Q

What are the indications for an endometrial biopsy?

A

Endometrium >4mm thick in post menopausal women
Endometrium >10mm thick in premenopausal women
Multiple episodes of post menopausal bleeding

70
Q

Give 2 differentials for PMB

A

Atrophic vaginitis

Cervical carcinoma

71
Q

What is a cervical ectropion?

A

Columnar cells visible as redness around the Os due to the cervix everting

72
Q

What is a risk factor for an ectropion?

A

Oral contraceptive pill and pregnancy

73
Q

What is the main symptom of an ectropion?

A

Post coital bleed

74
Q

What is the premalignant condition of the cervix called?

A

Cervical intraepithelial Neoplasia

75
Q

Which HPV strains carry the highest risk of cervical cancer/intraepithelial neoplasia?

76
Q

What is the treatment for cervical intraepithelial neoplasia?

A

Large loop excision of the transition zone

77
Q

What is the treatment of CIN if the abnormal area extends to the cervical canal?

A

Cone biopsy

78
Q

What is the most common kind of cervical cancer?

A

Squamous cell carcinoma

79
Q

What are the symptoms of cercival cancer?

A

Post coital bleeding, intermenstrual bleeding, abnormal discharge

80
Q

What is the treatment for the earliest stage cervical cancer?

A

Cone biopsy

81
Q

What is the treatment for cervical cancer stage 1aii-2a

A

Wetheim’s hysterectomy or chemo-radiotherapy

Check for lymph node involvement

82
Q

What is the treatment for cervical cancer 2b+?

A

Palliative chemo-radiotherapy

83
Q

What is wetheim’s hysterectomy?

A

Total hysterectomy includin upper third of vagina, ovaries, fallopian tubes and cervix

84
Q

slide 60

85
Q

What hormone triggers ovulation?

A

LH - Lutenising hormone

86
Q

What is the triad of PCOS?

A

Polycystic ovary appearance on ultrasound
hirsuitism
irregular periods/oligomenorrhoea

87
Q

What is “polycystic ovary” on ultrasound?

A

multiple small follicles on an enlarged ovary

88
Q

What is clinical and biochemical hirsutism?

A 
Clinical = acne/excess body hair
Biochemical = raised testosterone levels
89
Q

What would you see in the blood of someone with PCOS?

A

Raised LH, raised insulin and raised androgens

90
Q

What would the TSH, prolactin and FSH look like in PCOS?

91
Q

How to treat PCOS?

A

weightloss advice

Combined pill

92
Q

How would you treat someone with PCOS if they wanted to conceive?

A

clomiphene

93
Q

What is clomiphene?

A

Infertility treatment for women who do not ovulate - it is an ovulatory stimulant

94
Q

Which cancer is increased in women with PCOS?

A

endometrial cancer

95
Q

What is a chocolate cyst?

A

endometrioma caused by endometriosis: accumulation of blood in the ovary forming a dark brown chocolate coloured cyst

96
Q

Urinary frequency and abdominal pain and distension could be…

A

An ovarian cyst pressing on the bladder

97
Q

What is the first line investigation for suspected ovarian rupture/torsion?

A

Pelvic ultrasound

98
Q

What must you rule out if someone comes with a suspected ovarian cyst/torsion/rupture? And what investigations would rule them out?

A

Cancer - CA125
Ectopic pregnancy - pregnancy test
Urinalysis

99
Q

Who gets ovarian cancer?

A

Women over 50, most aged 80-84

100
Q

Name 3 genes associated with ovarian cancer?

A

HNPCC, BRCA 1 and 2

101
Q

What, broadly, increases your risk of ovarian cancer? (Give examples)

A

More ovulation

  • Nulliparity
  • early menarche and late menopause
102
Q

Name 2 cancers the pill is protective for

A

ovarian and endometrial cancer

103
Q

Females with IBS who are over 50 should all have….

A

CA125 - Ovarian cancer presents like IBS:

  • bloating
  • loss of appetite
  • urinary frequency/urgency
104
Q

How are women with a family history of ovarian cancer managed?

A

Yearly ultrasounds and CA125

105
Q

how is the Risk of Malignancy Index (RMI) calculated in ovarian cancer?

A

menopausal status (1-3) x ultrasound features x serum ca 125

106
Q

What are low, medium and high RMI scores?

A

< 25 = low
25-250 = medium
>250 = high

107
Q

What is the premalignant condition in vulval cancer?

A

Vulval Intraepithelial Neoplasia

108
Q

Give 3 risk factors for vulval cancer

A

HPV
Smoking
immunosuppression

109
Q

Where are 2 common sites for endometriosis?

A

On/behind ovaries

Uterosacral ligament

110
Q

What is “frozen pelvis”?

A

When endometriosis causes organs in the pelvis to adhese

111
Q

What is the gold standard investigation of endometriosis?

A

Laparoscopy and biopsy

112
Q

Risk factors for prolapse

A

vaginal delivery
menopause
congenital factors

113
Q

What is the proper name for thrush?

A

Candida albicans

114
Q

What can cause candida albicans?

A

Diabetes
Washing with soap
Antibiotics
Pregnancy

115
Q

What is the treatment for thrush?

A

Fluclonazole

116
Q

What are the symptoms of thrush?

A

Itching
cottage cheese discharge
superficial dyspareunia

117
Q

What are the symptoms of BV?

A

Grey-white discharge

fish smelling discharge

118
Q

Treatment for BV?

A

Metronidazole or clindamycin cream

119
Q

Risk factors for STIs

A

under 25
prostitute
multiple parnters
no condom use

120
Q

What is the treatment of chlamydia?

A

Azithromycin

121
Q

What is the treatment for gonorrhoea?

A

IM ceftriaxone

122
Q

What are the 2 ways of getting pelvic inflammatory disease?

A

Ascending infection from the endocervical region OR descending infection from the abdomen

123
Q

Pelvic pain, deep dyspareunia, irregular bleeding and discharge are symptoms of what?

A

Pelvic inflammatory disease

124
Q

List 3 investigations for PID

A
  1. Endocervical swabs for chlamydia and gonorrhoea
  2. Blood test raised inflammatory markers
  3. Ultrasound to exclude abscess/cyst
125
Q

What antibiotics are used to treat PID?

A

Ceftriaxone and doxycycline

126
Q

Complications of PID?

A

Ectopic pregnancy, infertility, chronic pelvic pain

127
Q

What do you visualise on ultrasound and laproscopy of PID?

A

fluid collections on ultrasound, adhesions on laproscopy

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