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Gynaecological disorders Flashcards

1
Q

Define menorrhagia

A

Prolonged and increased menstrual flow

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2
Q

Define metrorrhagia

A

Regular intermenstrual bleeding

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3
Q

Define polymenorrhoea

A

Menses occurring at <21 day intervals

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4
Q

Define polymenorrhagia

A

Increased bleeding and frequent cycle

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5
Q

Define amenorrhoea

A

Primary = failure of menarche by age 16

Secondary = cessation of periods for >6 months in a patient who has previously menstruated

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6
Q

Define oligomenorrhoea

A

Menses at intervals >35 days / <9 times per year

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7
Q

What are some of the organic causes of menorrhagia?

A 
Fibroids 
Polyps  
Pelvic inflammatory disease 
Malignancy 
e.t.c
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8
Q

What are some of the systemic causes of menorrhagia?

A 
Endocrine disorders 
Liver disorders 
Renal disorders 
Disorders of haemostasis 
Drugs - anticoagulants
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9
Q

What is meant by ‘dysfunctional uterine bleeding’?

A

Menorrhagia in the absence of underlying pathology

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10
Q

Anovulatory DUB is more likely to occur in which patients?

A

Patients at the extremes of reproductive age and obese women

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11
Q

Ovulatory DUB is more likely to occur in patients of what age?

A

Women aged 35-35 years

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12
Q

What are some of the management options for DUB?

A

Medical therapy: Progestogens, COCP e.t.c

Progesterone releasing IUCD

Endometrial resection/ hysterectomy

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13
Q

Which micro-organisms are associated with causing endometriosis?

A

Neisseria

Chlamydia

TB

CMV

HSV

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14
Q

How do endometrial polyps present?

A

Usually ASYMPTOMATIC but may present with BLEEDING or DISCHARGE

Occurs around and after the menopause

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15
Q

What is adenomyosis and how does it present?

A

Endometrial glands and stroma within the myometrium

Menorrhagia and dysmenorrhoea

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16
Q

What is leiomyoma and how does it present?

A

Benign tumour of smooth muscle (can be found at locations other than the uterus)

Menorrhagia, infertility, mass effect and pain

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17
Q

Endometrial thickness can be determines by vaginal ultrasound. What thickness is an indication for biopsy to be performed?

A

> 4mm in postmenopausal women

16mm in premenopausal women

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18
Q

What is meant by the term vaginismus?

A

Involuntary tightening of the muscles around the vagina when penetration is attempted

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19
Q

What is meant by the term dyspareunia?

A

Pain during intercourse

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20
Q

What are the differentials for a uterine mass?

A

Endometrial cancer

Fibroids

Pregnancy

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21
Q

What are the differentials for a tubal swelling?

A

Ectopic pregnancy

Hydrosalpinx

Pyosalpinx

Paratubal cysts

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22
Q

What are the differentials for an ovarian mass?

A

Ovarian tumour/ cancer

Ovarian cysts

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23
Q

What are the differentials for an ACUTE presentation of a pelvic mass?

A

Cyst rupture

Fibroid degeneration

Ectopic pregnancy

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24
Q

What are endometrial polyps?

A

Benign outgrowths of stroma and glands

Often occur around the menopause

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25
What hormone is responsible for endometrial hyperplasia?
Oestrogen causes endometrial proliferation Progesterone usually causes shed at menstruation, so unopposed oestrogen causes hyperplasia
26
What is the biggest risk factor for endometrial hyperplasia?
Obesity
27
How is endometrial hyperplasia managed?
Mirena coil
28
What is the most common type of endometrial carcinoma?
Adenocarcinoma
29
What underlying conditions should you consider in young women presenting with endometrial cancer?
PCOS Lynch syndrome - HNPCC
30
How does endometrial cancer present?
Post menopausal bleeding Heavy or irregular bleeding in pre-menopausal women
31
What is the gold standard management for endometrial cancer What other management options are there?
Hysterectomy Chemo and radiotherapy Hormonal therapy with progesterone only - mirena coil or oral progesterone
32
What are the 2 types of endometrial carcinoma?
Endometrioid carcinoma and serous carcinoma
33
What is the most common type of endometrial carcinoma?
Endometroid
34
Why is obesity a risk factor for endometrial carcinoma?
Adipocytes express aromatase which converts ovarian androgens to oestrogen Oestrogen causes endometrial proliferation
35
What is Lynch syndrome?
Cancer predisposition syndrome High risk of colorectal cancer and endometrial cancer in women
36
What are leiomyomas?
Fibroids | benign smooth muscle tumours on the uterus
37
When do fibroids get bigger and when do they get smaller?
Fibroids are oestrogen dependent and so enlarge in pregnancy and when on the OCP They atrophy after the menopause
38
How do fibroids present?
Menorrhagia Infertility Pelvic mass Pain/ tenderness
39
What investigations are done for fibroids?
US MRI Hb if bleeding is heavy
40
What is a leiomyosarcoma?
Malignant smooth muscle tumour
41
What is the most common uterine sarcoma?
Leiomyosarcoma
42
What is the prognosis like for leiomyosarcoma?
Poor - 14-25% 5 year survival rate
43
What are functional ovarian cysts?
Follicular cysts or cysts from the corpus luteum
44
How do functional cysts present?
Often asymptomatic Menstrual disturbance, pain
45
What is endometriosis?
Endometrial glands and stroma outside the uterine body (in the wrong place)
46
How do endometriomas on the ovaries present?
Severe dysmenorrhoea and premenstrual pain Dyspareunia Subfertility Tender mass
47
How are ovarian tumours managed if they are benign vs malignant?
benign - removal/ drainage malignant - surgery/ chemo
48
What are the 4 main types of epithelial ovarian tumours?
Serous Mucinous Endometrioid Brenner (transitional) Clear cell (serous and mucinous are the most common)
49
What is the most common benign ovarian tumour?
Serous cyst adenomas | epithelial tumour
50
Which ovarian tumour can become enormous?
Mucinous | epithelial tumour
51
Chocolate cysts are what type of ovarian tumour?
Endometrioid | epithelial tumour
52
What type of ovarian tumour is derived from transitional type epithelium?
Brenner
53
What are the main types of germ cell tumours of the ovary?
Benign cystic teratoma Malignant germ cell tumour (choriocarcinomas) Dysgerminoma
54
What is the most common ovarian tumour in young women?
Benign cystic teratoma?
55
Which type of ovarian tumour is totipotential (capable of developing into any body cell type) and may have components of hair, teeth, thyroid tissue etc?
Benign cystic teratoma
56
Which type of ovarian tumour occurs almost exclusively in children and young women?
Dysgerminoma
57
What are the main types of sex chord/ stromal ovarian tumours?
Granulosa cell tumours Sertoli-Leydig cell tumours Fibromas
58
Which ovarian tumour may cause hirsutism and virilisation?
Sertoli-Leydig cell tumours
59
What 3 things make up Meig's syndrome?
Ovarian fibromas Ascites Pleural effusions
60
How does ovarian cancer present?
Bloating/ ascites Abdominal pain Weight loss / loss of appetite
61
What are the genetic associations of ovarian cancer?
BRCA 1 & 2 HNPCC (Lynch syndrome)
62
What are the risk factors and protective factors for ovarian cancer?
With each ovulation the ovary is damaged slightly - so things associated with more ovulation are risk factors and those associated with less are protective Risk factors; increasing age, early menarche and late menopause, FH Protective factors; OCP, pregnancy and breast feeding, tubal ligation
63
What are the tumour markers for ovarian cancer?
CA 125 CEA
64
What investigations are done for ovarian cancer?
Tumour markers Cytology of pleural/ ascitic fluid Imaging; US/ CT
65
What are the treatment options for ovarian cancer?
Hysterectomy and bilateral salpingectomy Chemotherapy; carboplatin + paclitaxel Hormonal therapy; tamoxifen/ aromatase inhibitors
66
What causes cervical cancer?
70% caused by HPV 16 and 18 30% caused by other strains of HPV or very rarely due to Peutz-Jeghers syndrome
67
What are the risk factors for cervical cancer?
HPV - Early age of intercourse/ many partners Smoking OCP
68
How does cervical cancer present?
PCM/ IMB/ PMB
69
How is ovarian cancer treated?
Surgery Radiotherapy Chemotherapy (cisplatin/ cargo-latin)
70
What are the management options for an overactive bladder?
Bladder training Antimuscarinics B3 agonists Desmopressin Botox
71
Give an example of an antimuscarinic drug which can be used in the management of overactive bladder
oxybutynin
72
Give an example of a B3 agonist which can be used in the management of overactive bladder How do B3 agonists work?
Mirabegron Inhibit contractions and increase relaxation of bladder smooth muscle
73
What are the management options for stress urinary incontinence?
Weight loss and pelvic floor exercises Duloxetine Surgery
74
What are the symptoms of a prolapse?
Pressure and dragging sensation Difficulty voiding/ defecating/ inserting a tampon Pain on intercourse
75
What is a cystocele?
Bladder herniates/ bulges into the vaginal wall
76
What is a rectocele?
Rectum herniates/ bulges into the posterior wall of the vagina
77
What is an enterocele?
Loops of intestine herniate/ bulge into the vaginal wall
78
What is a uterine prolapse?
Protrusion of the uterus downwards into the vagina
79
What is uterine providentia?
The uterus lies outside the vagina
80
What are the management options for prolapse?
Weight loss Pessary Surgery
81
When can topical oestrogens be used for OAB?
Topical oestrogens can be used for OAB if there is atrophy of the vaginal mucosa
82
How is PCOS inherited?
Autosomal dominant inheritance
83
2/3 of which criteria are needed for diagnosis of PCOS?
Chronic anovulation Polycystic ovaries Hyperandrogenism (clinical or biochemical)
84
What are the biochemical/ hormone levels in a patient with PCOS?
Low progesterone High LH and FSH Normal oestrogen
85
What are the treatment options for PCOS?
WEIGHT LOSS Metformin Oral contraceptive pill Antioestrogens (clomifene citrate and tamoxifen) Aromatase inhibitors Laparoscopic surgery
86
What is premature ovarian failure?
Cessation of menstruation eat <40 years of age
87
What hormone levels are required for diagnosis of premature ovarian failure?
FSH> 30 on 2 separate occasions 1 month apart
88
What are the biochemical/ hormone levels in a patient with premature ovarian failure?
High LH and FSH Low oestrogen
89
What is hydrosalpinx?
Distally blocked fallopian tube
90
Where is the pain in a patient with ovarian torsion?
Left iliac fossa Right iliac fossa; appendicitis
91
Do lesbians who have never had sex with a male partner need to have cervical screening?
Yes HPV can be transmitted through lesbian sex
92
How often should women aged 50-64 have cervical smears taken?
Every 5 years
93
What is the only definitive treatment for adenomyosis?
Hysterectomy
94
What test should be performed in ALL women presenting with heavy menstrual bleeding?
FBCs
95
What are the management options for menorrhagia in women who do not require contraception?
Mefenamic acid or tranexamic acid | both started on the first day of the period
96
What are the management options for menorrhagia in women who do require contraception?
IUS (mirena coil) is first-line COC Long acting progestogens
97
What condition presents with cyclical pain and development of secondary sexual characteristics, but no menstruation?
Inperforate hymen
98
How can metformin be used to improve fertility in PCOS?
Metformin acts to increase peripheral insulin sensitivity This is beneficial as most patients with PCOS have some degree of insulin resistance which affects the hypothalamic pituitary ovarian axis
99
What are some of the risk factors and protective factors for endometrial cancer?
Risk factors - PCOS - Nulliparity - Oestrogen only HRT - Tamoxifen Protective factors - COCP - Smoking
100
What are the main red flags for ovarian cancer?
Bloating Abdominal pain Fluctuating bowel habit
101
Which type of cervical cancer has better prognosis?
Squamous cell carcinomas have better prognosis than adenocarcinomas
102
What are the treatment options for vulval cancer?
Radical vulvectomy +/- Inguinal lymphadenopathy
103
Which type of ovarian cancer is the most associated with the BRCA mutation?
Serous epithelial ovarian cancer
104
Why are progesterone only hormonal therapies used in the management of endometrial cancer?
To balance out the unopposed oestrogen

REPRODUCTION (12 decks)

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