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Gynaecology 1 Flashcards

1
Q

Amenorrhoea definition
Primary

A

Primary: failure to establish menses by 15yo with secondary sexual characteristics or 13yo if no secondary sexual characteristics

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2
Q

Amenorrhoea definition
Secondary

A

Cessation of menses for 3-6 months in women with previously normal and regular menses
Or 6-12 months in women with previous oligomenorrhoea

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3
Q

Postpartum hypopituitarism caused by necrosis of the pituitary gland.

A

Sheehan’s

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4
Q

An acquired condition where scar tissue (adhesions) form inside your uterus

A

Asherman’s syndrome

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5
Q

Investigations for amenorrhoea

A

FBC, U+E, Coeliacs, TFTs, prolactin, androgen levels, oestradiol, gonadotrophins

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6
Q

Amenorrhoea screen
Raised gonadotrophins versus low

A

Raised = ovarian cause
Low = hypothalamic cause

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7
Q

Bleeding in the first trimester
Who should be referred to an early pregnancy assessment service?

A

> =6 weeks

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8
Q

How is bleeding for <6K managed?

A

If no pain or RF for ectopic then to return if bleeding develops
Repeat pregnancy test in 7-10days and return if positive
If negative then = miscarriage

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9
Q

Most common type of cervical ca?

A

SCC 80%
Adeno 20%

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10
Q

HPV serotypes that can increase risk of cervical ca (3)

A

16,18, 33

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11
Q

Cervical ca RF (8)

A

HPV
Smoking
HIV
Early first intercourse
Many sexual partners
High parity
Lower socioeconomic status
COCP

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12
Q

Cervical screening ages:

A

25-49 - every 3 years (Scotland every 5 years)
50-64 - every 5 years

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13
Q

Cervical screening in pregnancy

A

Delay for 3 months post partum unless missed screening or previous abnormal smears

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14
Q

Screening explained/ results explained
HPV negative =

A

HPV negative - return to normal recall

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15
Q

Screening explained/ results explained
HPV +ve =

A

Cytology if normal then repeat test at 12 months

Cytology if abnormal then for colposcopy

If inadequate then repeat sample within 3 months, if x2 inadequate then colposcopy

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16
Q

Mx of patients who have been treated for CIN 1/2/3

A

Test of cure repeat cervical sample at 6 months

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17
Q

Mx cervical ectropion

A

Ablative treatment such as cold coagulation

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18
Q

Primary dysmenorrhoea =
Mx (3)

A

No underlying pelvic pathology
Pain during and a few hours prior to the period starting
Mx mefanamic acid and ibuprofen
2nd line COCP

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19
Q

Secondary dysmenorrhoea (how does it differ from primary)

CKS Mx

A

Usually starts a few days prior to the period
Refer all patients with secondary dysmenorrhoea to gynae

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20
Q

Ectopic pregnancy bHCG

A

> 1500

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21
Q

Endometrial cancer is classically seen in which group of women?

A

Post menopausal

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22
Q

RF endometrial cancer (9)

A

Nulliparity
Early menarche
Late menopause
Obesity
Unopposed oestrogen
DM
Tamoxifen
PCOS
Hereditary colorectal ca

23
Q

Cervical versus endometrial ca RF

A

Early first intercourse
High parity

Endo - nulliparity, late menopause

Smoking and COCP RF for cervical but protective for endo ca

24
Q

Symptoms of endometrial ca (2)

A

PMB, IMB in premenopausal women

25
Q

Ix for suspected endometrial ca
Who gets put on a 2ww?
TVUS ET less than ?mm = high negative predictive value
Ix (2)

A

> =55yo with PMB = 2ww
TVUS ET <4mm = high negative predictive value
Hysteroscopy with endometrial biopsy

26
Q

Mx endo ca

A

TAH + BSO +/- post op RT
OR
Progestogen therapy if frail and old

27
Q

Protective factors for endometrial ca

A

COCP and smoking

28
Q

Endometrial hyperplasia feature (1)
Mx
Simple (2)
Atypia (1)

A

IMB/ abnormal vaginal bleeding
Mx if simple - high dose prog and repeat sampling in 3-4 months or mirena
Atypia - hysterectomy

29
Q

Endometriosis mx
1st line
2nd line

A

1st line NSAIDs/ paracetamol
2nd line COCP or progestogens (medroxyprogesterone acetate)

30
Q

FGM types (4)

A

1 partial or total removal of clitoris/ prepuce
2 partial or total removal of clitoris and labia minora
3 narrowing of vaginal orifice
4 all other harmful procedures

31
Q

Fibroid degeneration symptoms (4)
Mx

A

Low grade fever, pain, vomiting, pregnancy

Mx resolve within 4-7 days rest and analgesia

32
Q

HMB Mx
If does not (2) and does require contraception (3)

A

If doesn’t require contraception
Mefanamic acid
TXA
(Start of first day of period)

If does
1. Mirena
2. COCP
3. Long acting progestogens

33
Q

What can be used in the short term to rapidly stop HMB?

A

Norethisterone 5mg TDS

34
Q

What is a blighted ovum?

A

Gestational sac >25mm but no embryonic or fetal part is seen

35
Q

TOP
Gestation
Who is needed to sign?

A

K24
x2 medical practitioners (or one in an emergency)

36
Q

TOP Mx

A

<K9 mifepristone followed 48 hours later by PG
<K13 D&C
>K15 D&evacuation

37
Q

Semen analysis
Abstinence for how long?
Sample to be delivered in what time period?

A

3-5 days
1 hour

38
Q

Normal semen results
volume
pH
Sperm concentration
Morphology
Motility
Vitality

A

Normal semen results*
volume > 1.5 ml
pH > 7.2
sperm concentration > 15 million / ml
morphology > 4% normal forms
motility > 32% progressive motility
vitality > 58% live spermatozoa

39
Q

Definition of recurrent miscarriages

A

3 or more consecutive miscarriages

40
Q

Causes of recurrent miscarriages (7)

A

Antiphospholipid syndrome
PCOS
DM
Thyroid issues
Uterine septum
Smoking
Parental chromosomal abnormalities

41
Q

Mx pruritus vulvae

A

Showers not baths
Emmolients OD
Underlying conditions = topical steroids
Seborrhoeic dermatitis - anitfungal combined with steroid

42
Q

Pruritus vulvae usually has …

A

An underlying cause

43
Q

HRT complications
HINT BEoVIS

A

Increased risk of
Breast ca
EndOmetrial ca
Ovarian ca
VTE
Ischaemic heart disease if taken more than 10 years after menopause
Stroke

44
Q

Hyperemesis triad definition:

A

Triad:
5% pre-pregnancy weight loss
Dehydration
Electrolyte imbalance

45
Q

Hyperemesis Mx
1st line (3)
2nd line (2)

A

1st line PO cyclizine/ PO promethazine/ PO prochlorperazine

2nd line ondansetron/ metoclopramide

46
Q

Which anti-emetic can increase the risk of cleft lip/palate?

A

Ondansetron

47
Q

Investigations for infertility (2)

A

D21 serum prog + semen analysis

48
Q

D21 prog interpretation

A

<16 = repeat, if consistently low then refer to fertility clinic
16-30 repeat
>30 indicates ovulation

49
Q

Counselling for infertility:
Medication
BMI
Sex how often?

A
  1. Folic acid
  2. BMI 20-25
  3. Regular sexual intercourse every 2-3 days
50
Q

Define premature ovarian insufficiency

A

Onset of menopausal symptoms before the age of 40

51
Q

Hormone levels in premature ovarian insufficiency

FSH LH oestradiol
Numbers for FSH and LH

A

Raised FSH LH

FSH >40
Must be demonstrated on 2 blood samples taken 4-6 weeks apart

Low oestradiol <100

52
Q

Mx premature ovarian insufficiency

A

COCP until average age of menopause (51yo)
Then HRT

53
Q

Meig’s syndrome

A

Benign ovarian tumour (usually a fibroma) associated with ascites and pleural effusion

AKT (52 decks)

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