Gynaecology Flashcards
Type of ovarian growth most commonly associated with Meig’s syndrome
Fibroma
Commonest benign ovarian tumour <25y
Dermoid cyst/Teratoma
Most common cause of ovarian enlargement in women of a reproductive age
Follicular cyst
Management of mild PMS
Sleep, exercise, smoking, alcohol
Small carby meals
Management of moderate PMS
New-gen COCP (Yasmin)
Management of severe PMS
SSRI (continuous or luteal)
Stress incontinence - 1st line
Pelvic floor training >3m
Stress incontinence - 2nd line
Surgery
Stress incontinence - 2nd line (declined surgery)
Duloxetine
Duloxetine - type of drug
SNRI
Urge incontinence - 1st line
Bladder retraining >6wks
Urge incontinence - 2nd line
Antimuscarinic
oxybutinin, tolterodine, darifenacin
Urge incontinence - drug used in elderly
Mirabegron (beta-3 agonist)
Primary dysmenorrhoea - 1st line management
NSAID (ibuprofen/ mefenamic acid)
Primary dysmenorrhoea - 2nd line management
COCP
Causes of menorrhagia
Dysfunctional/idiopathic Anovulatory cycles Fibroids Hypoythyroidism Copper coil PID vWD
Mirabegron side effects
Severe HTN
Tachycardia
Menopausal >50y - contraception is needed until
Amenorrhoeic 12 months
Menopausal <50y - contraception is needed until
Amenorrhoeic 24 months
RF for Ovarian Ca
BRCA1/BRCA2
Early menarche
Late menopause
Nulliparity
Recurrent vaginal candidiasis
> =4 episodes/year
Management of recurrent vaginal candidiasis
Fluconazole OD for 3 days,
then weekly for 6 months
Risk factors for endometrial cancer
Obesity
Early menarche, late menopause, nulliparity)
Unopposed oestrogen
Diabetes
Tamoxifen
PCOS
HNPCC
Associated with hyperemesis gravidarum
Multiple pregnancy Trophoblastic disease Hyperthyroidism Nulliparity Obesity
Menorrhagia (not requiring contraception) - 1st line management
Mefenamic acid 500mg TDS
or
Tranexamic acid 1g TDS
When should mefenamic acid/tranexamic acid be started for menorrhagia
First day of the period
Menorrhagia (requires contraception) - 1st line management
Mirena
Menorrhagia (requires contraception)- 2nd line management
COCP / long-acting progestogen
Menorrhagia - acute short-term management
Norethisterone 5mg TDS
Definition of primary amenorrhoea
No menstruation by age 15
or
No menstruation or secondary sexual characteristics by age 13
2ww referral criteria for endometrial cancer - refer all:
> =55y + postmenopausal bleeding
Ovarian cyst seen on US - premenopausal woman
Repeat US in 8-12 weeks
+
Consider referral if persists
Ovarian cyst seen on US - postmenopausal woman
Refer to gynae
Factors protective against endometrial cancer
COCP
Smoking
Causes of cervical ectropion
Elevated oestrogen levels:
- Ovulatory phase
- Pregnancy
- COCP
Causes of secondary dysmenorrhoea
Endometriosis Adenomyosis PID Fibroids Copper coil
Non-hormonal management of hot flushes in menopause
SSRI/SNRI
Clonidine
Gabapentin
CBT
1st line medications for vomiting in pregnancy
Antihistamine (cyclizine, promethazine)
Phenothiazone (prochlorperazone, chlorpromazine)
‘Xonvea’ (doxylamine/pyridoxine)
2nd line medications for vomiting in pregnancy
Dopamine receptor antagonist (metoclopramide, domperidone)
5-HT3 receptor antagonist (ondansetron)
Most common ovarian cancer
Serous carcinoma
Smear test is offered 3-yearly to women aged
25-49
Smear test is offered 5-yearly to women aged
50-64
HRT: adding progestogen increases the risk of
Breast cancer
VTE
HRT: adding progestogen decreases the risk of
Endometrial cancer
Hirsutism in PCOS - 1st line
COCP (third-generation or co-cyprindiol)
Hirsutism in PCOS - 2nd line or if COCP not appropriate
Topical eflornithine
Hirsutism in PCOS - 3rd line options (under specialist supervision)
Spironolactone
Flutamide
Finasteride
Cervical screening - 2nd repeat smear at 24 months is still hrHPV +ve (cytology normal)
Refer to colposcopy
Cervical screening - from routine recall - hrHP +ve, cytology normal
Repeat smear at 12 months
Cervical screening - hrHP +ve at routine smear. Repeat smear at 12 months: hrHP +ve, cytology normal
Further repeat smear in another 12 months
Cervical screening - hrHP +ve at routine smear. Repeat smear at 12 months: hrHP -ve
Return to routine recall
Cervical screening - hrHP +ve at routine smear and 12 month smear. Repeat smear at 24 months hrHP -ve
Return to routine recall
