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Finals Revision > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

How would you investigate somebody with heavy menstrual bleeding?

A

Full history: duration, frequency, volume, presence of clots
Associated symptoms, any IM bleeding, pain, signs of infection
Clotting abnormalities/bleeding disorders

TV, abdominal and speculum examinations

Bloods: FBC, clotting

TV/Abdominal USS

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2
Q

What is the treatment for menorrhagia?

A

Mirena coil= first line
COCP if opposed to a coil

TXA or mefanamic acid for non-hormonal/contraceptive option

Surgical: endometrial ablation, myomectomy of fibroids, hysterectomy

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3
Q

What are the differentials for dysfunctional uterine bleeding?

A

Polyps
Adenomyosis
Leiomyoma (fibroids)
Malignancy

Coagulopathy
Ovarian dysfunction
Endometrial processes
Iatrogenic e.g. anticoagulants
No clear cause
STIs
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4
Q

What are the symptoms of uterine fibroids?

A

Dysfunctional/heavy bleeding
Dysmenorrhoea
Abdominal bloating/palpable mass
Subfertility

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5
Q

How should fibroids be investigated?

A

Full obstetric and gynaecological history
Abdominal, PV and speculum examination
TVUSS

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6
Q

How can fibroids be managed?

A

If not too troublesome, don’t need to be treated.
For bleeding: COCP / TXA + mefanamic acid
Surgical methods: uterine artery embolisation, myomectomy, hysterectomy

Recommended surgical treatment for those still wanting to conceive = myomectomy

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7
Q

What are the characteristic symptoms of BV?

A

White/grey discharge

Offensive smell- fishy

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8
Q

How is BV diagnosed?

A 
Combination of:
presence of homogenous white/grey discharge
characteristic foul-smell
vaginal pH >5.5
clue cells on microscopy
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9
Q

How is BV managed?

A

Oral metronidazole: 2g stat dose or 5 day course
alt- topical clindamycin

Avoid over-washing

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10
Q

What are the symptoms of chlamydia (if there are any)

A

Dysuria
Abnormal discharge
Abnormal PV bleeding

In men: penile discharge
May present with complications: epididymo-orchitis, Reiter synd: arthritis/conjunc/urethritis

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11
Q

How is chlamydia treated?

A

Azithromycin 1g STAT
Doxycycline 7 day course
Oral erythromycin in pregnancy

Contact tracing + no unprotected sex for 1 week

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12
Q

Which types of HPV cause warts?

A

6 & 11

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13
Q

Which types of HPV cause cervical cancer?

A

16 & 18

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14
Q

What are the symptoms of HPV?

A

May be asymptomatic
Painless lumps in genito-anal region
Genital itch/contact bleeding

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15
Q

How is HPV diagnosed?

A

Clinical diagnosis

Smear testing

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16
Q

How is HPV treated?

A

Cryotherapy 1st line
Topical podophyllotoxin or imiquimod - not in pregnancy
Surgical removal

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17
Q

What are the complications of chlamydia?

A

PID
Tubal infertility
Reiter syndrome: reactive arthritis, conjunctivitis, urethritis
Epididymo-orchitis
Fitz-Hugh-Curtis syndrome: perihepatitis syndrome

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18
Q

What would chlamydia look like on gram stain?

A

Gram negative

Can be rod or cocci

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19
Q

What would gonorrhoea look like on gram stain?

A

Gram negative diplococci

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20
Q

How is gonorrhoea managed?

A

IM ceftriaxone + stat 1g oral azithromycin

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21
Q

Which type of HSV causes genital herpes?

A

HSV 2

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22
Q

What are the symptoms of genital herpes?

A

Prodromal genital itch and pain
Painful genital blisters
Inguinal lymphadenopathy
May also have general flu-like illness

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23
Q

How is herpes diagnosed?

A

Clinical appearance

PCR of blister fluid

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24
Q

How is herpes treated?

A 
No cure
Contact tracing
Topical anaesthetics + simple analgesia
Oral acyclovir 5 days
No unprotected sex while blisters still present
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25
Q

What are the symptoms of trichomonas vaginalis?

A

Yellow-green discharge, may be frothy and foul smelling
Strawberry cervix
Dysuria, vaginal soreness/itchiness

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26
Q

How is trichomonas diagnosed?

A

Wet smear from posterior fornix

27
Q

How is trichomonas vaginalis treated?

A

Stat dose oral metronidazole 2g OR 5-7 day course

28
Q

What are the signs of primary syphilis?

A

Painless genital ulcer: chancre

Inguinal lymphadenopathy

29
Q

What are the symptoms of secondary syphilis?

A

Widespread lymphadenopathy
Generalised rash on palms and soles
Anterior uveitis
Genital wart-like lesions: condyloma lata

30
Q

How is syphilis diagnosed?

A

Treponemal + non-treponemal enzyme immunoassay

If both positive: syphilis
If trep +ve and non-trep -ve: primary/latent
If trep -ve and non-trep +ve: false positive result
If both negative: no syphilis

31
Q

How is syphilis managed?

A

IM Benzathine benzylpenicillin stat

32
Q

How is vaginal candidiasis managed?

A

Topical Clotrimazole cream or pessary

Oral fluconazole- omit in pregnancy

33
Q

What are the symptoms of PID?

A 
Lower abdominal pain
Discharge- classically foul smelling
Abdominal tenderness
Systemic symptoms- fever, vomiting
Abnormal bleeding, painful/irregular periods
Deep dyspareunia

Cervical excitation

Can present with sepsis/pelvic abscesses

34
Q

What investigations are indicated in suspected PID?

A 
Full gynaecological history
Abdominal, PV, speculum examination
Comprehensive PV swabs
Bloods: FBC, CRP, cultures if septic, B-hcg
TV USS
Laparoscopy= gold standard but invasive
35
Q

How is PID managed?

A

Contact tracing
Sepsis 6 if septic
IV antibiotics- ceftriaxone and doxycycline -> oral metronidazole and doxy 14/7
If milder- IM ceftriaxone STAT and oral doxy 14/7

36
Q

What are the potential complications of PID?

A 
Tube-Ovarian abscesses, tubal strictures -> reduced fertility
Sepsis
Fitz-Hugh-Curtis syndrome
Recurrent PID
Ectopic pregnancy
37
Q

What are the symptoms of endometriosis?

A

Chronic pelvic pain
Extremely painful periods which may also be heavy
Dysparaeunia, dysuria, pain on defaecation
Blood in urine and stool
Chronic fatigue, change in bowel habit
Subfertility

38
Q

How is endometriosis diagnosed?

A

Gold standard= laparoscopy, but this is invasive

TVUSS usually done first to look for endometriomas

39
Q

How is endometriosis managed?

A

COCP first line
Mirena coil
GNRH analogues
aromatase inhibitors

  • > surgical coagulation/ablation/excision of lesions
  • > hysterectomy as last resort
40
Q

Which nerve roots control the pelvic floor?

A

S2, 3 and 4

41
Q

What investigations should be done in somebody presenting with incontinence?

A

Urine dip- rule out UTI
Medication review + frequency/volume chart
Abdominal and vaginal examination- rule out prolapse, assess pelvic floor
Bladder scan- rule out incomplete bladder emptying
Urodynamics
Cystourethroscopy
Contrast enhanced CT

42
Q

What are the managements for stress incontinence?

A
  1. Weight loss, smoking cessation, manage triggers, reduce caffeine and alcohol
  2. Pelvic floor retraining
  3. Duloxetine- SNRI which helps enhance sphincter activity
  4. Colposuspension and urethral sling procedures
43
Q

How is urge incontinence managed?

A
  1. Bladder retraining e.g. double voiding, prophylactic voiding
  2. Pelvic floor strengthening
  3. Anti-muscarinic medication: oxybutynin
  4. To reduce anti-cholinergic burden in the elderly, use mirabegron
44
Q

How is overactive bladder syndrome managed?

A

Behavioural techniques: fluid restriction, caffeine and alcohol cessation,
Medication review
Bladder retraining
Anticholinergic medication: oxybutynin, mirabegron
Detrusor muscle botox
Sacral nerve stimulation
Detrusor myomectomy

45
Q

What is a procidentia?

A

3rd degree uterine prolapse

-> lowest part of the prolapse lies outside the vagina

46
Q

What are the symptoms of pelvic organ prolapse?

A

Uterine:
Dragging sensation down below / heaviness
Feeling of a mass, difficult inserting tampons
Dyspareunia
Leakage of urine
Perineal pain

Cysto-urethrocele:
Urgency, frequency, nocturia, recurrent UTI, incontinence

Rectocele:
Constipation, difficulty defecating

47
Q

How would you investigate suspected uterine organ prolapse?

A

Bimanual and speculum examination - cough test
Assessment of pelvic floor muscle strength
USS to exclude any masses
Urodynamics if suffering incontinence

48
Q

How can pelvic organ prolapse be managed?

A
  1. Pelvic floor exercises
  2. Vaginal cones
  3. Intra-vaginal pessary: need changing every 6 months, topical oestrogen to prevent atrophy
  4. Surgical repair: hysterectomy, ligament suspension, anterior/posterior/paravaginal repair
49
Q

What is the gold standard test for ovarian torsion?

A

Pelvic ultrasound with doppler colour flow to assess blood supply

50
Q

What are the symptoms of PCOS?

A 
Oligo/amenorrhoea
Hirsutism
Acne
Weight gain/inability to lose weight
Alopecia
Subfertility
51
Q

What are the diagnostic criteria for PCOS?

A

ROTTERDAM CRITERIA
Symptomatic + Clinical + Investigative

Symptoms of oligo/amenorrhoea/subfertility
Clinical signs of hyperandrogegism: hirsutism, acne
USS evidence of polycystic ovaries/ovary volume >10ml

52
Q

How would you investigate suspected PCOS?

A

Full history and menstrual history
Bloods: FSH, LH and oestrogen, androgens + prolactin
High LH, FSH + oestrogen normal/slightly low
Raised androgens, prolactin normal (excludes other cause of amenorrhoea)
Pelvic USS

53
Q

How is PCOS managed?

A

Weight loss
COCP and metformin to try and regulate periods
Antiandrogens e.g. finasteride, spironolactone to try and reduce symptoms
Hair removal/laser
Acne treatment
If trying to conceive: clomiphene, ovarian diathermy

54
Q

How often is the depot-provera given?

A

Every 12-13 weeks

55
Q

What are the disadvantages associated with the contraceptive injection?

A

Weight gain
Irregular periods
Can take <12m for fertility to return

56
Q

Which methods of contraception are associated with drug interactions?

A

Implant
Contraceptive patch
Combined oral contraceptive

anticonvulsants, St John’s wort, macrolides, rifampicin, HIV medication

57
Q

What are the starting rules for the COCP/injection/implant/IUD?

A

If started in first 5 days of cycle: immediate protection

Otherwise, 7 day window in which barrier contraception should be used

58
Q

What are the starting rules for the POP?

A

If in first 5 days of cycle, immediate protection

If later, need barrier protection for 48 hours

59
Q

What are the missed pill rules for the COCP?

A

1 missed: take missed one ASAP and continue as normal (ie take 2 on first day)
2+ missed: if in week 2-3, take last missed one, condoms 7 days
if in week 1, consider EC, take last missed one, condoms 7 days

If you ever vomit within 2 hours of taking the pill, take another
If suffering from severe diarrhoea, use condoms until at least 2 days after symptoms resolve

60
Q

When can each type of contraception be started again after pregnancy?

A

COCP: if breastfeeding then after 6 weeks
if started on day 21 PP, immediate protection- any later then need condoms 7 days
POP: can be started immediately, but if later than 21 days PP then need condoms 48 hours
Implant/injection: can be started immediately, but if later than 21 days PP then need condoms 7 days
IUD/IUS: can be inserted either immediately after birth or after 4 weeks

61
Q

Which type of emergency contraception is contraindicated in asthmatics?

A

Ella-one

62
Q

Which type of emergency contraception requires barrier protection until the next period?

A

Ella-one

Binds to progesterone receptors so can interfere with hormonal contraceptives

63
Q

Which is the most effective and reliable emergency contraception?

A

Copper coil

Finals Revision (23 decks)

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