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AMK > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Sx fibroids

A

Often asymptomatic
Can present as suprapubic mass and menorrhagia

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2
Q

Ix fibroids

A

Transvaginal US and bimanual exam

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3
Q

Treatment for fibroids <3cm

A

Mirena coil and NSAIDs

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4
Q

Tx fibroids >3cm

A

surgery

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5
Q

Sx endometriosis

A

Cyclical abdo pain

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6
Q

Ix endometriosis

A

Laparoscopy

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7
Q

Tx endometriosis

A

Analgesics and COCP

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8
Q

Sx ectopic pregnancy

A

Sholder tip pain
Unilateral pelvic pain
Vaginal bleeding

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9
Q

Ix ectopic pregnancy

A

Transvaginal US

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10
Q

Stress incontinence

A

Leaking of urine when intra-abdominal pressure increases

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11
Q

Tx stress incontinence

A

Pelvic floor exercises
Fluoxetine

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12
Q

Urge incontinence

A

Sudden loss of urine

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13
Q

Tx urge incontinence

A

Bladder training
Anticholinergics - oxybutynin

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14
Q

What is primary amenorrhoea?

A

Absence of periods in >15 girls with secondary sexual features or >13 without secondary sexual features

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15
Q

Causes of primary amenorrhoea

A

Turner’s, anorexia, malformed genital tract etc

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16
Q

Tx primary amenorrhoea

A

HRT

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17
Q

What is secondary amenorrhoea

A

No menstruation for 3-6 months if previously normal menses or 6-12 months if previous oligomenorrhoea

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18
Q

Causes of secondary amenorrhoea

A

Exercise, PCOS, hyperprolactinaemia, Sheehan’s/Asherman’s

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19
Q

When do you do artificial insemination?

A

Poor sperm or difficulty having sex

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20
Q

When do you do IVF?

A

If woman is <43 y/o, can screen genetics

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21
Q

What is a bartholin’s abscess?

A

Infected bartholin’s glands

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22
Q

treatment bartholin’s abscess

A

ABx and marsupialization

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23
Q

what is a bartholin’s cyst?

A

The duct becomes blocked, which leads to a build up of mucus

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24
Q

Sx bartholin’s cyst

A
  • Normally painless
  • Large cysts cause pain sitting etc
  • Unilateral
  • Soft, painless lump
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25
Q

treatment bartholin’s cyst

A

asymptomatic = no intervention

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26
Q

Cause of 1st trimester bleeding

A
  • Miscarriage
  • Ectopic pregnancy (+ve test with abdo pain, pelvic/cervical tenderness)
  • Implantation bleeding
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27
Q

Management bleeding >6 weeks pregnant

A

early pregnancy assessment

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28
Q

Management bleeding <6 weeks + no ectopic sx

A

manage expectantly and safety net

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29
Q

Symptoms ectopic pregnancy

A
  • bHCG>1500
  • Lower abdo pain - constant and unilateral
  • Vaginal bleeding - dark brown and little amount
  • Amenorrhoea for 6-8 weeks
  • Dizziness/syncope
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30
Q

What is dyspareunia?

A

Pain during/after sexual intercourse

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31
Q

Causes of superficial dyspareunia

A

Lack of arousal. vaginal atrophy
vaginitis/vaginismus

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32
Q

Causes of deep dyspareunia

A

PID
endometriosis/adenomyosis

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33
Q

What is dysmenorrhoea

A

painful periods

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34
Q

Primary dysmenorrhoea

A

Usually in younger pts as periods start, no underlying pathology, due to excess prostaglandins

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35
Q

Mx primary dysmenorrhoea

A

NSAIDs to reduce prostaglandin production

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36
Q

what is secondary dysmenorrhoea

A

Usually in older patients due to pathology

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37
Q

Management secondary dysmenorrhoea

A

gynae referral

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38
Q

What does a blue cervix indicate?

A

Chadwick’s sign for early pregnancy

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39
Q

Cervical ectropion

A

Columnar epithelialium extends into ectocervix and causes post-coital bleeding

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40
Q

How to differentiate ruptured ovarian cyst vs ovarian torsion

A

Ovarian cyst has symptoms in the past

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41
Q

Signet-ring cell on biopsy

A

Ovarian cancer metastases from stomach

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42
Q

Treatment Bartholin’s abscess/cyst

A

Word catheter, normally e.coli

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43
Q

How to differentiate between adenomyosis and endometriosis

A

adenomyosis uterus feels enlarged

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44
Q

most treatable cancer

A

choriocarcinoma

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45
Q

Management bleeding >6 weeks of pregnancy

A

Refer to early pregnancy unit

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46
Q

Management of bleeding <6 weeks of pregnancy

A

manage expectantly and safety net

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47
Q

sx ectopic pregnancy

A

bHCG >1500
Lower abdo pain
Dark brown vaginal bleeding
Amenorrhoea

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48
Q

Management primary dysmenorrhoea

A

NSAIDs to reduce prostaglandins

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49
Q

Management secondary dysmenorrhoea

A

Gynae referral

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50
Q

Risk factors for endometrial cancer

A

Obesity, nulliparity, increased oestrogen exposure

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51
Q

Sx endometrial cancer

A

post-menopausal bleeding

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52
Q

Ix endometrial cancer

A

> 55 with bleeding needs 2ww and trans-vaginal US

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53
Q

management endometrial cancer

A

hysterectomy with bilateral salpino-oophorectomy

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54
Q

what is fibroid degeneration?

A

fibroids are sensitive to oestrogen so grow in pregnancy. if they out-grow supply then they can degenerate

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55
Q

sx fibroid degeneration

A

pain, fever, vomiting

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56
Q

management fibroid degeneration

A

analgesia, self resolves <1 week

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57
Q

Investigations for heavy periods

A

FBC and trans-vaginal US

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58
Q

treatment for heavy bleeding if contraception needed

A

Mirena coil IUS
COCP

59
Q

treatment for heavy bleeding if no contraception needed

A

tranexamic/mefenamic acid if pain

60
Q

HRT side effects

A

nausea, tender breasts, weight gain, increased risk of breast/endometrial cancer and VTE

61
Q

When do you normally see hyperemesis gravidarum?

A

8-12 weeks

62
Q

Protective factor for morning sickness

A

Smoking

63
Q

Diagnosis morning sickness

A

Dehydration, electrolyte imbalance and 5% weight loss

64
Q

Management hyperemesis gravidarum

A

antihistamine (cyclising) or ondansetron/metocloprmaide

65
Q

side effect ondansetron

A

increased risk of cleft palate

66
Q

side effect metoclopramide

A

EPSEs

67
Q

main cause of infertility

A

male factor

68
Q

investigations for infertility

A

semen analysis and progesterone 7 days before period expected

69
Q

progesterone results infertility

A

> 30 means ovulating
16-30 needs repeat
<16 needs repeat and referral

70
Q

management of post-menopausal woman with cyst

A

urgent gynaecology referral

71
Q

RF endometrial cancer

A

increased oestrogen

72
Q

treatment for localised endometrial cancer

A

hysterectomy + bilateral salpino-oophorectomy

73
Q

Types of HRT

A

oestrogen alone or oestrogen + progesterone

74
Q

When should you prescribe combined HRT?

A

If woman has a uterus (just oestrogen increases endometrial cancer risk) give combined

75
Q

What is the point of HRT?

A

A drop in oestrogen (menopause) is associated with vasomotor symptoms (flushing, insomnia, headaches) so this counteracts that

76
Q

Indications for HRT

A

Indications include vasomotor symptoms (headaches, flushing, insomnia) and premature menopause (continue until ≥50 to reduce osteoporosis risk

77
Q

When do you favour transdermal over oral HRT

A

if at high risk of VTE (smoker, obese, past stroke etc)

78
Q

what does oestrogen increase your chances of getting?

A

endometrial and breast cancer and VTE

79
Q

A 50-year-old woman attends requesting hormone replacement therapy (HRT). She has been experiencing hot flushes, night sweats, mood swings, vaginal dryness and reduced libido.

Her last period was 10 months ago and her uterus is intact. She is obese but has no other risk factors and has been counselled on the risks and benefits.

What HRT regimen would be most appropriate?

A

transdermal cyclical regimen - continuous should not be used within 12m of LMP

80
Q

What is VIN?

A

pre-squamous cell vulval carcinoma

81
Q

RF for vulval cancer

A

HPV 16 and 18, HSV 2

82
Q

lesions vulval cancer

A

itchy/burning, raised, inguinal lymphadenopathy

83
Q

tx vulval cancer

A

surgery, chemo and radio

84
Q

diagnosing fibroids

A

TVUS

85
Q

Urge incontinence

A

Overactive detrusor - sudden urge and then urine passes

86
Q

mx urge incontinence

A

oxybutynin and bladder re-training >6w

87
Q

stress incontinence

A

Increased abdo pressure causes urine to leak

88
Q

mx stress incontinence

A

duloxetine, pelvic floor retraining (8 exercises TDS for >3m)

89
Q

Up to how many weeks can you abort a baby?

A

24

90
Q

TOP <9 weeks

A

mifepristone followed by misoprostol (a prostaglandin to induce contractions) 48h later

91
Q

TOP <13 weeks

A

surgical dilation and evacuation

92
Q

TOP >15 weeks

A

surgical dilation and evacuation to induce mini labour

93
Q

define recurrent miscarriage

A

> 3 consecutive and spontaneous miscarriages, often due to anti phospholipid syndrome, endocrine disorders, uterine abnormality etc

94
Q

cause of pruritus vulvae

A

irritation - commonly condoms

95
Q

mx pruritus vulvae

A

take showers not baths, wash once a day

96
Q

pruritus vulvae vs ani

A

ani is perianal area, vulvae is vulval area

97
Q

sx pruritus vulvae

A

itching

98
Q

How long is follicular phase?

A

ALWAYS 14

99
Q

What happens during follicular phase (hormones)

A

Egg (ovum) is developing inside follicle
Hypothalamus secretes GnRH which acts on ant.pituitary to secrete FSH and LH
FSH stimulates a few follicles
The granulosa cells surrounding these follicles secrete oestrogen
Oestrogen has -ve feedback on hypothalamus = less FSH and LH
Dip in ovulation as cells mature means FSH and LH spike = ovulation

100
Q

What happens during luteal phase (hormones)

A

Successful follicle releases ovum and collapses to form CL
CL secretes progesterone
If pregnant, placenta takes over progesterone production from 12 weeks to maintain lining and thicken cervical mucus
Cells also make oestrogen
if not pregnant, CL degenerates = less oestrogen and progesterone (menstruation)
This means no negative feedback
FSH and LH rise again

101
Q

Hormonal changes in menopause

A

low oestrogen (which means less -ve feedback), high LH and FSH

102
Q

What is premature ovarian insufficiency?

A

Onset of menopausal sx and increased gonadotrophin levels before 40 yo

103
Q

Causes of premature ovarian insufficiency

A

idiopathic, bilateral oophorectomy, radio/chemo

104
Q

Sx menopause

A

night sweats/hot flushes, infertility, secondary amenorrhoea, hormonal changes

105
Q

what is PMS

A

emotional (stress, fatigue, anxiety, mood swings) and physical (bloating and breast pain) changes that occur in the luteal phase of an ovulatory cycle

106
Q

management for PMS (mild, mod and severe)

A

mild = lifestyle changes and frequent, small, carb-heavy meals
mod = COCP
severe = SSRI

107
Q

cervical excitation is a sign of

A

PID

108
Q

urogenital prolapse sx

A

pressure/heaviness, incontinence, ‘bearing down’

109
Q

Sx ovarian torsion

A

Colicky deep abdo pain, sudden onset, N and V, whirlpool USS

110
Q

Tx ovarian torsion

A

laparoscopy

111
Q

threatened miscarriage

A

os closed, painless bleeding with viable foetus

112
Q

missed miscarriage

A

os closed, no viable foetus, light bleeding/discharge with sx of pregnancy disappearing

113
Q

inevitable miscarriage

A

os open, heavy bleeding

114
Q

incomplete miscarriage

A

open os, products of conception partially expelled

115
Q

Average age of menopause

A

51

116
Q

For how long should women use contraception if menopausal sx >50?

A

12m

117
Q

For how long should women use contraception if <50

A

24m

118
Q

sx menopause

A
  • Change in cycle length
  • Hot flushes
  • Night sweats
  • Vaginal dryness
  • Psychological SEs
119
Q

mx menopause

A
  • Lifestyle changes
  • Vasomotor sx can be treated with fluoxetine/citalopram
  • If woman has uterus, give her transdermal combined HRT (oestrogen alone increases risk of cancers)
  • Vaginal oestrogen may be required for life for urogenital atrophy
120
Q

rapid acting treatment for heavy vaginal bleeding

A

Norethisterone 5 mg tds

121
Q

sx ectropion

A

vaginal discharge
post-coital bleeding

122
Q

mx ectropion

A

ablation

123
Q

what is cervical ectropion?

A

On the ectocervix, the transformation zone is where the stratified squamous epithelium meets the columnar epithelium of endocervix. High oestrogen levels result in a larger area of columnar epithelium being present on the ectocervix

124
Q

How should you refer women >55 with post-menopausal bleeding

A

2ww

125
Q

management endometriosis

A

NSAIDs/paracetamol
COCP

126
Q

intermenstrual bleeding

A

endometrial hyperplasia

127
Q

type 1 FGM

A

clitoridectomy

128
Q

type 2 FGM

A

removal of clitoris and labia minor, +/- labia major

129
Q

type 3 FGM

A

Narrowing of vaginal orifice with creation of covering seal using the labia minora/majora (infundibulation)

130
Q

type 4

A

all other harmful procedures to female genitalia

131
Q

how to postpone periods

A

norethisterone to be taken 3 days before the onset of her periods until when you want period to be, will not offer contraception

132
Q

treatment of thrush if pregnant

A

topical

133
Q

when do you do a HVS for thrush?

A

if symptoms are unclear - if clinical diagnosis is clear, treat straight away

134
Q

tests if recurrent candidiasis

A

diabetes and HVS

135
Q

most common cause of recurrent first trimester miscarriage

A

anti-phospholipid syndrome

136
Q

what is antiphospholipid syndrome?

A

arterial/venous thromboses, recurrent foetal loss and thrombocytopenia

137
Q

management anti-phospholipid syndrome

A

aspirin once pregnancy confirmed on urine dip
heparin once fetal heart seen -> 34 weeks

138
Q

treatment for severe PMS

A

SSRI in luteal phase

139
Q

how many episodes of candidiasis in a year for it to be classed as recurrent?

A

4

140
Q

Low oestrogen, high FSH and LH

A

premature ovarian insufficiency

141
Q

example muscarinic antagonist for urge incontinence

A

tolterodine

142
Q

PROM happens before how many weeks?

A

37

143
Q

Stillbirth is defined after how many weeks?

A

24

AMK (33 decks)

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