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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
What are the symptoms of trichomonas vaginalis?
Yellow-green discharge, may be frothy and foul smelling Strawberry cervix Dysuria, vaginal soreness/itchiness
26
How is trichomonas diagnosed?
Wet smear from posterior fornix
27
How is trichomonas vaginalis treated?
Stat dose oral metronidazole 2g OR 5-7 day course
28
What are the signs of primary syphilis?
Painless genital ulcer: chancre | Inguinal lymphadenopathy
29
What are the symptoms of secondary syphilis?
Widespread lymphadenopathy Generalised rash on palms and soles Anterior uveitis Genital wart-like lesions: condyloma lata
30
How is syphilis diagnosed?
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
How is syphilis managed?
IM Benzathine benzylpenicillin stat
32
How is vaginal candidiasis managed?
Topical Clotrimazole cream or pessary | Oral fluconazole- omit in pregnancy
33
What are the symptoms of PID?
``` 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
What investigations are indicated in suspected PID?
``` 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
How is PID managed?
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
What are the potential complications of PID?
``` Tube-Ovarian abscesses, tubal strictures -> reduced fertility Sepsis Fitz-Hugh-Curtis syndrome Recurrent PID Ectopic pregnancy ```
37
What are the symptoms of endometriosis?
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
How is endometriosis diagnosed?
Gold standard= laparoscopy, but this is invasive | TVUSS usually done first to look for endometriomas
39
How is endometriosis managed?
COCP first line Mirena coil GNRH analogues aromatase inhibitors - > surgical coagulation/ablation/excision of lesions - >hysterectomy as last resort
40
Which nerve roots control the pelvic floor?
S2, 3 and 4
41
What investigations should be done in somebody presenting with incontinence?
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
What are the managements for stress incontinence?
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
How is urge incontinence managed?
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
How is overactive bladder syndrome managed?
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
What is a procidentia?
3rd degree uterine prolapse | -> lowest part of the prolapse lies outside the vagina
46
What are the symptoms of pelvic organ prolapse?
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
How would you investigate suspected uterine organ prolapse?
Bimanual and speculum examination - cough test Assessment of pelvic floor muscle strength USS to exclude any masses Urodynamics if suffering incontinence
48
How can pelvic organ prolapse be managed?
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
What is the gold standard test for ovarian torsion?
Pelvic ultrasound with doppler colour flow to assess blood supply
50
What are the symptoms of PCOS?
``` Oligo/amenorrhoea Hirsutism Acne Weight gain/inability to lose weight Alopecia Subfertility ```
51
What are the diagnostic criteria for PCOS?
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
How would you investigate suspected PCOS?
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
How is PCOS managed?
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
How often is the depot-provera given?
Every 12-13 weeks
55
What are the disadvantages associated with the contraceptive injection?
Weight gain Irregular periods Can take <12m for fertility to return
56
Which methods of contraception are associated with drug interactions?
Implant Contraceptive patch Combined oral contraceptive anticonvulsants, St John's wort, macrolides, rifampicin, HIV medication
57
What are the starting rules for the COCP/injection/implant/IUD?
If started in first 5 days of cycle: immediate protection | Otherwise, 7 day window in which barrier contraception should be used
58
What are the starting rules for the POP?
If in first 5 days of cycle, immediate protection | If later, need barrier protection for 48 hours
59
What are the missed pill rules for the COCP?
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
When can each type of contraception be started again after pregnancy?
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
Which type of emergency contraception is contraindicated in asthmatics?
Ella-one
62
Which type of emergency contraception requires barrier protection until the next period?
Ella-one | Binds to progesterone receptors so can interfere with hormonal contraceptives
63
Which is the most effective and reliable emergency contraception?
Copper coil

Finals Revision (23 decks)

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