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MBChB 5 > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What are the benefits of HRT?

A

Reduction in vasomotor symptoms, improvement in urogenital symptoms, improvement in sexual function, reduced risk of osteoporosis, reduced risk of colorectal cancer

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2
Q

What are the risks of HRT?

A

Increased risk of breast cancer (especially combined HRT), increased risk of endometrial cancer in unopposed oestrogens, increased risk of VTE, increased risk of gallstones

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3
Q

When should cyclical HRT be used over continuous HRT?

A

Women still having or < 12 months since LMP

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4
Q

What are the risk factors for cervical cancer?

A

Persistent diagnosed high risk HPV, multiple sexual partners, smoking, HIV, post-transplant, oral contraceptives (possibly due to reduced use of barrier contraception)

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5
Q

How should CIN be treated?

A

CIN I - 6 monthly colposcopy, CIN II or III - LLETZ with 6 months follow up smear

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6
Q

What are the signs and symptoms of cervical cancer?

A

Post coital bleeding, post-menopausal bleeding, watery discharge, weight loss, ureteric obstruction, vesicovaginal fistula.
Exam - irregular cervical surface, abnormal vessels and dense uptake of acetic acid. Rough, fixed cervix with contact bleeding.

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7
Q

What are the risk factors for endometrial cancer?

A

Obesity, nulliparity, anovulatary cycles, early late manopause, HNPCC, HRT, tamoxifen

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8
Q

What are the symptoms of ovarian cysts?

A

Chronic pain, dyspareunia, acute pain (tortion or bleeding), irregular bleeding, sudden androgenism, ascites

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9
Q

How should ovarian cysts be investigated?

A

FBC, CA125, AFP, LDH, hCG and CEA

TVUS then MRI if complex

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10
Q

How should ovarian cysts be managed in a premenopausal woman?

A

If small, asymptomatic and no risk of malignancy - observe. Otherwise - laparoscopic cystectomy

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11
Q

How should ovarian cysts be managed in a postmenopausal woman?

A

Calculate RMI - if low risk repeat CA125 and TVS every 4 months until clear for 1 year. Moderate risk = bilateral oopherectomy If high risk = referral to cancer centre for staging laparoscopy

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12
Q

What are the risk factors for ovarian cancer?

A

Nulliparity, eary menarche ad late menopause, BRCA genes especially BRCA1, HNPCC,

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13
Q

How does ovarian cancer present?

A

Presumed IBS, bloating, unexplained weight loss, loss of appetite, feeling full early, increased urinary frequency, change in bowel habit, abdominal or pelvic pain, veinal bleeding, fixed pelvic mass on VE, pleural effusion, ascites and lymphadenopathy

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14
Q

How should ovarian cancer be investigated?

A

Similar to cyst work up bloods. TVUS, CXR, CT abdo pelvis, MEI, ascitic/pleural tap,

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15
Q

How should ovarian cancer be managed?

A

Full staging laparotomy (midline laparotomy with hysterectomy, bilateral salpingo-oopherectomy, omentectomy, para-aortic and pelvic lymph node sampling and peritoneal washings.
Chemotherapy

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16
Q

Explain the pathogenesis of endometriosis.

A

Retrograde menstruation leading to adherance and growth of endometrial tissue, metaplasia, imapired immunity to retrograde menstruation

17
Q

How does endometriosis present?

A

Pain: cyclical, constant if adhesions, severe dysmenorrhoea, deep dyspareunia, dysuria, dyschezia
Subfertility
Speculum may show lesions on the cervix
Fixed, retroverted uterus of VE

18
Q

How should suspected endometriosis be investigated?

A

TVUS to look for cysts, MRI for bowel involvement, Laparoscopy and biopsy 3 months after hormonal therapy stops
CA125 may be raised

19
Q

How should mild endometriosis be managed in women who do not currently wish to conceive?

A

NSAIDs or COCP

20
Q

How should moderate endometriosis be managed in women who do not wish to conceive?

A

Mirena IUS

21
Q

What medical management options are available to women who wish to conceive?

A

GnRH analogues short term along with IVF

22
Q

What surgical management options are available for women with endometriosis?

A

Laparoscopic ablation, excision and coagulation of endometriomas.
Hysterectomy may be the last resort for women who do not wish to conceive or accept this as a trade-off.

23
Q

What is the definition of heavy menstrual bleeding?

A

Menstruation which the woman feels to be excessive

24
Q

What are the causes of heavy menstrual bleeding?

A

Endometriosis, adenomyosis, PID, IUD, anticoagulants, Von Willebrand’s disease, diabetes, hypothyroidism, endometrial hyperplasia, PCOS

25
Q

What are the medical management options for dysfunctional uterine bleeding?

A

If contraception is desired - IUS/COCP or cyclical progesterone
Tranexamic acid if painless, mefenamic acid if painful.

26
Q

What is the definition of primary amenorrhoea?

A

No menstruation at age 13 without any other pubertal changes, or at age 15 with other signs of puberty

27
Q

What are the causes of hypogonadotropic hypogonadism?

A

Hypopituaritrism, chronic illness (cystic fibrosis, IBD), anorexia nervosa, constitutional delay, hypothyroid, Cushing’s syndrome, Kallman’s syndrome

28
Q

What are the causes of hypogonadotropic hypogonadism?

A

Damage to gonads, congenital absence of gonads, Turner’s syndrome

29
Q

What is the definition of secondary amenorrhoea?

A

No menstruation for more than three months after previous regular menstrual periods

30
Q

What are the causes of secondary amenorrhoea?

A 
Pregnancy is the most common cause
Menopause and premature ovarian failure
Hormonal contraception (e.g. IUS or POP)
Hypothalamic or pituitary pathology
Ovarian causes such as polycystic ovarian syndrome
Uterine pathology such as Asherman’s syndrome
Thyroid pathology
Hyperprolactinaemia
31
Q

What is the pathological term for fibroids?

A

Uterine leiomyoma

32
Q

How do fibroids typically present?

A

Heavy menstrual bleeding
Prolonged menstruation, lasting more than 7 days
Abdominal pain, worse during menstruation
Bloating or feeling full in the abdomen
Urinary or bowel symptoms due to pelvic pressure or fullness
Deep dyspareunia (pain during intercourse)
Reduced fertility

33
Q

How should fibroids be investigated?

A

Hysteroscopy is the initial investigation for submucosal fibroids presenting with heavy menstrual bleeding.

Pelvic ultrasound is the investigation of choice for larger fibroids.

MRI scanning may be considered before surgical options, where more information is needed about the size, shape and blood supply of the fibroids.

34
Q

How should small fibroids (<3cm) be managed?

A

Mirena coil (1st line) – fibroids must be less than 3cm with no distortion of the uterus
Symptomatic management with NSAIDs and tranexamic acid
Combined oral contraceptive
Cyclical oral progestogens

Surgery - Endometrial ablation
Resection of submucosal fibroids during a hysteroscopy
Hysterectomy

35
Q

How should large fibroids (>3cm) be managed?

A

Should be referred to gynaecology

Can be managed medically with NSAIDs, and contraceptives
GnRH agonists may be used pre-op to shrink fibroids

Uterine artery embolisation
Myomectomy - improves fertility
Hysterectomy

36
Q

What are the complications associated with fibroids?

A

Heavy menstrual bleeding
Reduced fertility
Miscarriages, premature labour and obstructive delivery
Constipation
Urinary outflow obstruction and infection
Red degeneration of the fibroid
Torsion of the fibroid
Malignant change to a leiomyosarcoma is very rare (<1%)

37
Q

What is red degeneration of the fibroid?

A

Red degeneration refers to ischaemia, infarction and necrosis of the fibroid due to disrupted blood supply. Red degeneration is more likely to occur in larger fibroids (above 5 cm) during the second and third trimester of pregnancy. Red degeneration may occur as the fibroid rapidly enlarges during pregnancy, outgrowing its blood supply and becoming ischaemic.

It may also occur due to kinking in the blood vessels as the uterus changes shape and expands during pregnancy.

Red degeneration presents with severe abdominal pain, low-grade fever, tachycardia and often vomiting. Management is supportive, with rest, fluids and analgesia.

MBChB 5 (7 decks)

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