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AA Y4 Finals cards NE > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

on bimanual examination, what condition causes pain on palpation (also known as excitation)?

A

PID

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2
Q

what is the method of action of transexamic acid?

A

anti fibrinolytic

taken during period to reduce amount of blood loss

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3
Q

what is the method of action of mefanemic acid?

A

anti prostaglandin (NSAID)

taken during period to reduce amount of pain

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4
Q

how is dysfunctional uterine bleeding managed in those who do not require contraception?

Ie- symptomatic management

A

for the bleeding: trasexamic acid

for the pain: mefanamic acid

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5
Q

how is DUB managed in those who require contraception?

Ie: controlling periods

A

1st line: mirena coil
2nd line: COCP
3rd line: IM progesterones

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6
Q

what cause of primary amenorrhoea presents with webbed neck, short stature and Shield shaped chest?

A

turner’s syndrome (45X)

one of the X chromosomes is totally or partially missing
affects only women

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7
Q

how can gonadotropin levels in amenorrhoea direct you to where the problem is?

A

low gonadotropin levels suggest hypothalamic location

high gonadotrophin levels suggest ovary problem

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8
Q

in ovarian failure, describe FSH and LH levels?

A

they are HIGH

they are trying to make the failing ovaries produce more oestrogen

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9
Q

why is there insulin resistance in PCOS?

A

due to the high androgen levels

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10
Q

how are periods and hirsutism controlled in PCOS?

A

COCP

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11
Q

how is fertility treated in PCOS?

what class is this drug?

A

clomifene citrate - an anti oestrogen

causes ovulation in 70-80% of women with ovulatory dysfunction

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12
Q

how is fertility treated in PCOS?

what class is this drug?

A

clomifene citrate - an anti oestrogen

causes ovulation in 70-80% of women with ovulatory dysfunction

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13
Q

what must post menopausal bleeding be investigated as until proven otherwise?

A

endometrial cancer

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14
Q

what is the most common type of cervical cancer?

A

squamous cell cancer (80%)

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15
Q

which specific patients are the only ones eligible for oestrogen-only HRT when treating the menopause? why?

A

only women who don’t have a uterus are eligible for oestrogen-only HRT

unopposed oestrogen increases the risk of endometrial cancer

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16
Q

what is the investigation of choice in an ectopic pregnancy?

A

transvaginal U/S

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17
Q

what size must an ectopic pregnancy be under to be considered for medical or expectant management?

A

<35mm

if >35mm then surgical management is required

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18
Q

what is given in medical management of an ectopic pregnancy?

A

methotrexate (an anti metabolite)

it can only be done if the patient is willing to attend follow up

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19
Q

what is the 1st and 2nd line treatment for endometriosis?

A

1st line: NSAIDS or paracetamol

2nd line: COCP or progestogens

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20
Q

if NSAIDs and COCP do not relieve symptoms in endometriosis, what else can be trialled, 3rd line?

A

3rd line: GnRH analogue injections

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21
Q

compare the gold standard investigations for endometriosis and ectopic pregnancies?

A

endometriosis: laparoscopy

ectopic pregnancy: transvaginal US

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22
Q

what is the only effective treatment for large fibroids causing problems with fertility?

A

myomectomy

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23
Q

where is the most common site for an ectopic pregnancy to occur?

A

the ampulla of the uterine tubes

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24
Q

name 4 causes of an ectopic pregnancy?

A

anything that slows the transit of the fertilised ovum to the uterus:

  • endometriosis
  • PID due to STI (the inflammation)
  • damage to the tubes (surgery, previous ectopic)
  • IUCD in situ
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25
Q

what is the underlying cause of acute abdomen with pain radiating to the shoulder?

A

referred pain from peritoneal bleeding from ectopic rupture

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26
Q

describe what is seen in serial hCG tests in ectopic pregnancy?

A

in normal pregnancy, hCG values should double every 48 hours

in an ectopic pregnancy, they increase but they do NOT double every 48 hours

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27
Q

what is the difference between surgical management options in ectopic pregnancy?

A

salphingggectomy: removal of whole tube - done if women has 2 functional tubes
salphingotomy: removal of only the pregnancy - done if px has only one tube

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28
Q

which type of cancer can develop from a molar pregnancy?

where do these cancers commonly metastasise to?

A

choriocarcinoma

associated with a rapid metastasis to the lungs or liver

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29
Q

describe the bleeding pattern seen in molar pregancies?

A

intermittent or continual vaginal bleeding in 1st and 2nd trimester

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30
Q

describe investigation findings in molar pregnancies?

A

serum bhCG: very very high (>10,000)

US: no fetal heartbeat, snowstorm appearance

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31
Q

what is the definition of PID?

A

infection and inflammation of ovaries, uterus and tubes

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32
Q

what is the most common causative of PID?

A

chronic inflammation as a result of infection, most commonly chlamydia

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33
Q

how is PID investigated?

A

endocervical (high vaginal swab) which are usually negative

explorative laparotomy

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34
Q

state the antibiotic therapy given in cases of PID?

A

oral ofloxacin and metronidazole

or

orał doxycycline, IM ceftriaxone and oral metronidazole

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35
Q

which areas of the cervix make up the endocervix and which make up the ectocervix?

A

endocervix: makes up the endocervical canal
ectocervix: the cervix on the other side of the external OS

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36
Q

name the types of tissue that make up the endo and ecto cervix?

A

endocervix: columnar epithelial lined inner segment
ectocervix: non- stratified squamous cell epithelium

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37
Q

what happens to the squamo-columnar junction during puberty and pregnancy?

A

the columnar epithelium migrates down and results in the columnar epithelium of the junction being outside the external OS

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38
Q

what is the significance of the columnar epithelium migrating down to outside the external OS during puberty and pregnancy?

A

due to the exposure to the harsh environment of the vagina, it undergoes metaplasia to form the transitional zone

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39
Q

what is the definition of a cervical ectropion?

A

when the columnar epithelium is present at the ectocervix as a circular area around the external OS

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40
Q

how does a cervical ectropion present?

A

abnormal bleeding (post-coital, inter menstrual)

watery, non-smelly, non-itchy discharge

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41
Q

how is cervical ectropion managed?

A

silver nitrate cautery

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42
Q

how is a cervical polp different from an ectropion?

A

a cervical polyp is an benign growth of the endocervical tissue;
ie, it is more than just the columnar epithelium as seen in an ectropion

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43
Q

how is cervial polyps managed?

what must be ruled out?

A

avulsion

in older women, you must rule out endometrial cancer

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44
Q

which ages is cervical cancer highest in?

A

25-29 year olds

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45
Q

name which forms of contraception may increase risk of cervical cancer?

A

COCP: prolonged use can increase risk of cervical cancer

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46
Q

what is the precursor lesion of an invasive carcinoma?

A

CIN

carcinoma in situ

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47
Q

explain the definitions of CIN 1, 2 and 3?

A

CIN1: dyskaryosis extends no further than the basal 1/3rd of epithelium

CIN2: dyskaryosis extends 2/3 into epithelium

CIN3: full thickness dyskaryosis

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48
Q

what is the name given to the precursor lesion for invasive adenocarcinoma in cervical cancer?

A

gCIN

glandular CIN

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49
Q

in colposcopy, describe how acetic acid and iodine work?

A

acetic acid: turns abnormal areas white

iodine: turns normal areas brown

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50
Q

during colposcopy, which CIN require intervention?

what intervention is done?

A

only intervene if suspected CIN 2 or 3

  1. cold coagulation
  2. LLETZ- large loop excision biopsy of the transformation zone
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51
Q

what is the general underlying cause of the menopause?

A

ovaries become less responsive to FSH and LH

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52
Q

name 2 of the consequences of the ovaries becoming less responsive to LH and FSH during the menopause

A
  1. reduced ovarian production of oestrogen and progesterone

2. increased circulating levels of FSH and LH as no longer neg feedback control from oestrogen and progesterone

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53
Q

what is the most common cause of PMB?

A

atrophic vaginitis

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54
Q

describe the prophylactic treatment and then also the treatment once diagnosed with osteoporosis post menopause?

A

prophylactic: calcium and D supplements

treatment following diagnosis: biphosphonates

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55
Q

other than a clinical diagnosis, what blood test can be done to diagnose menopause?

A

serum FSH >430 x2, 6 weeks apart

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56
Q

why can oestrogen-only HRT only be used in women with hysterectomies?

A

the unopposed oestrogen is a risk factor for endometrial cancer

it stimulates endometrial cell proliferation, which increases likelihood of genetic mutations and malignant transformation

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57
Q

which type of HRT increases risk of breast cancer?

A

combined HRT

risk of breast cancer increased by progesterone

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58
Q

who is sequential HRT indicated for? what is the max length they can use sequential HRT for? why?

A

peri-menopausal women with womb

can only use it for max 2 years

it increases risk of endometrial cancer

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59
Q

other than the symptomatic control, name 2 other benefits of using HRT?

A
  • reduced risk of endometrial cancer

- prevention and treatment of osteoporosis

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60
Q

name 4 side effects of HRT?

A
  • nausea
  • weight gain
  • breast tenderness
  • fluid retention
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61
Q

name 4 factors that would contraindicate use of HRT?

A
  • current or past breast cancer
  • oestrogen sensitive cancer
  • undiagnosed vaginal bleeding
  • endometrial hyperplasia
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62
Q

what are the 2 main causes of primary premature ovarian failure

A

autoimmune conditions

chromosomal abnormalities

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63
Q

describe the investigations done in cases of premature ovarian failure?

A
  • repeat FSH and LH
  • do estradiol
  • check testosterone levels to rule out PCOS

-ovarian US only useful to look for congenital abnormalities

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64
Q

how is premature ovarian failure managed?

A

HRT essential to reduce risk of long term complications:

<52y/o = COCP or HRT

> 52y/o = HRT

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65
Q

describe the difference in presentation between a threatened and inevitable miscarriage?

A

threatened: no abdominal pain, light vaginal bleeding, cervical OS closed
inevitable: abdominal pain, heavy bleeding with clots and tissue, cervical OS open

fetal heartbeat detected in both

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66
Q

how is a threatened miscarriage managed?

A

reassurance and rest

monitor- increased risk of a preterm delivery

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67
Q

how is an inevitable miscarriage managed?

A
  • analgesia
  • allow time for uterus to evacuate itself
  • assisted evac: oxytocin, surgery
68
Q

what is the difference between an incomplete and complete miscarriage?

A

incomplete: fetus has passed but products of conception (POC) remain
complete: fetus and POC have passed

69
Q

how is an incomplete miscarriage managed?

A

miscarriage allowed to pass spontaneously over 7-14 days

monitor patient due to increased risk of hypovolemic shock

70
Q

what is the difference in the status of the cervix in complete and missed miscarriages, compared to the rest?

A

they are the only 2 where the cervix is closed

71
Q

what is a missed miscarriage? how is it managed?

A

fetus has died but has remained inside the uterus

managed as an abortion:
vaginal prostaglandin (misoprostol)
anti emetics and pain relief

72
Q

describe the test of cure pathway in cervical cancer?

A

tests done to ensure treatment has been effective

1st smear done at 6 months and oncogenic HPV also tested for then too (DOUBLE TEST)

73
Q

what is the gold standard management of cervical cancer?

what is the management option in a 1A, microscopic cancer to preserve fertility?

A

radical hysterectomy with bilateral pelvic node dissection

cone biopsy

74
Q

what are uterine fibroids dependant on?

A

oestrogen

they are oestrogen dependant smooth muscle tumours

75
Q

what is the 1st line curative option for uterine fibroids?

A

myomectomy - removal of just the fibroid, preserves the uterus

76
Q

describe red degeneration, a complication of uterine fibroids

A

occurs during pregnancy, when there is ^ oestrogen

there is thrombosis of the blood vessels supplying the fibroid and growth outstrips the blood supply

77
Q

describe the presentation of red degeneration?

A

in pregnant women

ab pain and localised peritoneal tenderness, fever and vomiting

78
Q

what is the 1st line medication used in ovulation induction?

A

letrozole

rates of live births are higher with letrozole than clomiphene citrate

79
Q

what is the 1st line management of hyperemesis gravidarum

A

anti histamines: promethazine or cyclizine

80
Q

why should metocloperamide not be used for more than 5 days in hyperemesis gravidarum?

A

it may cause extrapyramimdal side effects

81
Q

why does tamoxifen cause endometrial cancer?

A

tamoxifen acts as an anti-oestrogen in breast tissue, but as a pro-oestrogen on endometrial tissue

it causes uterine lining to grow

82
Q

when does the surge of progesterone produced by the corpus luteum typically peak?

what does this test confirm?

A

day 21

a high day 21 progesterone confirms ovulation

83
Q

what is 1st line for thrush in a non-pregnant women?

A

a single dose of oral fluconazole 150mg

84
Q

how is thrush in a pregnant women treated?

A

clotrimazole pessary

fluconazole is contraindicated

85
Q

compare FSH and LH levels in kallman’s syndrome and turner’s syndrome?

A

Kallman’s: FSH and LH LOW

Turner’s syndrome: FSH and LH HIGH

86
Q

what is the gold standard investigation for endometriosis?

A

laparoscopic visualisation of the pelvis

87
Q

name 3 contraindications to medical management of an ectopic pregancy?

A
  • foetal heartbeat
  • foetus measuring >35mm
  • ruptured ectopic pregancy
88
Q

name 2 complications of uterine fibroids?

A

acute abdomen - due to torsion of pedunculated fibroid

red degeneration - ab pain, localised peritoneal tenderness, N&V

89
Q

what causes endometriosis?

A

growth of endometrial tissue outwith the uterine cavity

90
Q

how does endometriosis present?

A

dysmenorrhoea (pain days before bleeding) and menorrhagia (painful periods)

chronic pelvic pain
deep dysparenunia and sub fertility

91
Q

which gynae condition typically causes pain days before bleeding and then painful periods?

A

endometriosis - causes cyclical, deep, pelvic pain

92
Q

what is the gold standard investigation for endometriosis?

A

explorative laparoscopy

93
Q

following symptomatic relief with analgesics, what is the 1st line medical management of endometriosis?

A

COCP - in endometriosis, it can be used ‘back to back’ without a free pill period

hormonal treatment may improve symptoms but not fertility

94
Q

what are endometriomas in the ovaries called?

A

“chocolate cysts”

95
Q

how is fertility affected by endometriosis?

A

fertility is reduced

96
Q

what is the only treatment that may improve fertility as well as symptoms in endometriosis?

A

laparoscopic surgery

surgery to remove ectopic endometrial tissue may return the anatomy to more of a normal state

97
Q

compare the most common types of cells that cause endometrial and cervical cancer?

A

endometrial cancer: most commonly adenocarcinomas

cervical cancer: squamous cell carcinoma

98
Q

other than adenocarcinoma, name the 3 other types of endometrial cancer?

A
  • stromal sarcoma
  • carcinocarcinoma
  • leiomyosarcoma
99
Q

name the 2 main risk factors for endometrial cancer?

A

obesity

diabetes

100
Q

what hormone drives endometrial hyperplasia and endometrial cancer?

A

unopposed estrogen

therefore, risk factors are any factors that cause states of unopposed oestrogen

101
Q

how does PCOS increase risk of endometrial cancer

A

infertile women do not ovulate

this means there is no corpus luteum, so no progesterone production = unopposed oestrogen

102
Q

why is obesity the crucial risk factor for endometrial cancer?

A

adipose is the main source of oestrogen in post menopausal women

= extra, unopposed oestrogen, which drives endometrial cancer

103
Q

describe the oestrogenic effect of tamoxifen?

A

it is an anti-oestrogenic on breast tissue

it has an oestrogenic effect on endometrial tissue

104
Q

name 4 protective factors in endometrial cancer?

A

anything that reduces unopposed oestrogen:

increased pregnancies
COCP
mirena coil
smoking - has an anti-oestrogenic effect

105
Q

what is the number 1 presenting feature of endometrial cancer?

A

postmenopausal bleeding

if women presents with this, she should be referred urgently under the 2 week wait cancer guidelines

106
Q

on transvaginal U/S in post menopausal women, what should the thickness of the endometrium be less than?

A

<4mm

107
Q

which 2 investigations are sufficient to discharge a women with queried endometrial cancer?

A

1) TV U/S <4mm endometrial thickness

2) pipelle biopsy showing normal endometrial tissue

108
Q

what hormone may be given to slow the progression of endometrial cancer?

A

progesterone

to oppose the oestrogen

109
Q

name the 2 types of endometrial hyperplasia?

A

hyperplasia without atypia

atypical hyperplasia

110
Q

compare treatment options for endometrial hyperplasia, without atypia and with atypia

A

without atypia: progesterones, either by:

  • IUS
  • continuous oral progesterones

with atypia: total hysterectomy and bilateral salphino-oophrectomy usually advised

111
Q

what is given post op in endometrial cancer?

A

vaginal brachytherapy (radio)

reduces recurrence

112
Q

what %age of women with ovarian cancer present once the cancer has spread beyond the pelvis? why?

A

70% present after cancer has spread past pelvis

ovarian cancer has non-specific symptoms

this results in a poor prognosis

113
Q

name the 4 types of ovarian cancers?

A

epithelial cell (most common)

dermoid cysts/germ cell tumours

sex cord-stomal tumours

metastasis

114
Q

name 4 subtypes of endothelial cell ovarian cancer?

A

serous (most common)
endometriod carcinomas
clear cell tumours
mucinous tumours

115
Q

which ovarian cancer has an association with Lynch syndrome?

A

endometriod tumour of the ovary

30% of women will also have a primary tumour in the endometrium

116
Q

which type of ovarian cancer contains cells with coffee bean nuclei and gland-like spaces called call-exner bodies?

A

granulosa cell tumours

117
Q

what type of cell do teratomas/germ cell tumours/dermoid cysts originate from?

A

germ cells

118
Q

which type of ovarian cancer may cause a raised AFP and hCG?

A

germ cell tumours

119
Q

which type of ovarian cancer is especially associated with ovarian torsion?

A

germ cell tumours

120
Q

what type of ovarian cancer is sertoli-leydig and granulosa cell tumours?

A

sex cord-stomal tumours

they are rare and can be benign or malignant

121
Q

what is the name of a tumour that has metastasised to the ovaries? where is it most likely to have metastasised from?

A

krukenberg tumour

most likely to have metastasised from GIT, esp the stomach

122
Q

which type of ovarian cancer has ‘signet-ring’ cells on histology?

A

krukenberg tumour

123
Q

compare the main factors that drive ovarian cancer and endometrial cancer?

A

increased ovulations increases risk of ovarian cancer

unopposed oestrogen increases risk of endometrial cancer

124
Q

what age does ovarian cancer peak at?

A

75 y/o

125
Q

name 3 protective factors for ovarian cancer?

A

anything that reduces the no of ovulations:

  • pregancy
  • breastfeeding
  • COCP
126
Q

name GI symptoms that may be due to ovarian cancer?

A 
early satiety 
bloating 
loss of appetite 
abdominal/pelvic masses 
ascites 
urinary symptoms
127
Q

why may an ovarian mass cause hip/groin pain?

A

ovarian mass presses on the obturator nerve, causing referred hip or groin pain

128
Q

what blood test should be done in a women with symptoms suggestive of ovarian cancer?

A

CA125

129
Q

what value of CA125 would be classed as significant?

A

> 35 IU/mL

130
Q

what tumour is CA125 a marker for?

A

epithelial cell ovarian cancer

131
Q

name 6 non-malignant causes of a raised CA125?

A 
endometriosis 
fibroids 
adenomyosis 
pregancy 
liver disease 
pelvic infection
132
Q

what type of ovarian cancer causes psammoma bodies?

A

serous cell ovarian cancer

a type of epithelial ovarian cancer

133
Q

compare what yolk sac, choriocarcinoma and dysgerminoma germ cell ovarian tumours secrete?

A

yolk sac: AFP

choriocarcinoma: HCG
dysgerminoma: HCG and LDH

134
Q

compare what sertoli leydig and granulosa sex cord ovarian tumours secrete?

A

sertoli leydig: secrete testosterone - can cause virilisation

granulosa cell tumours: secrete oestrogen

135
Q

what cancer does clomifene increase risk of?

A

ovarian cancer

136
Q

a family history of which cancers increases risk of ovarian cancer?

A

FHx of ovarian, breast or endometrial

aka- a BRCA1 or 2 mutation

137
Q

what is the 1st line imaging done in women with suspected ovarian cancer?

A

TV U/S

138
Q

what is usually diagnostic in ovarian cancer?

A

laparotomy during tissue sampling

139
Q

describe the order of investigations in suspected ovarian cancer

A
  1. CA125 tested.
  2. if CA125>35, then an urgent abdominal AND trans vag U/S is done
  3. staging via CT CAP
140
Q

which 2 cancers are people with HNPCC at an increased risk from?

A
  1. colorectal cancer

2. endometrial cancer

141
Q

name 3 things that progesterone HRT can increase risk of?

A
  • breast cancer
  • VTE
  • cardiovascular diseases
142
Q

how can progesterone be used to treat endometrial hyperplasia?

A

it causes the secretory phase of the endometrial cycle and then prevents the endometrium thickening afterwards

143
Q

why does endometrial hyperplasia also occur after the menopause?

A

ovulation has stopped and progesterone is no longer being produced

therefore, there is unopposed oestrogen, which is a risk factor for endometrial hyperplasia

144
Q

compare the 2 types of endometrial carcinomas that can present?

A

type 1: endometriod carcinoma - oestrogen dependant, results from endometrial hyperplasia and diagnosed just after the menopause

type 2: serous and clear cell, diagnosed in older women and has a poorer prognosis as it is much more aggressive

145
Q

name the precursor lesion for type 1 endometriod carcinomas?

A

endometrial hyperplasia

146
Q

which type of endometrial carcinoma is most common?

A

type 1, endometriod carcinoma

147
Q

name the precursor lesion for type 2, serous and clear cell endometrial cancers?

A

serous endometrial intraepithelial carcinoma

148
Q

which type of endometrial carcinoma is associated with microsatellite instability?

A

type 1 endometrial carcinoma

149
Q

what is a micro satellite instability?

A

a germline mutation of mismatch repair genes (Lynch syndrome)

150
Q

which endometrial carcinoma is due to a TP53 mutation?

A

type 2 serous and clear cell

151
Q

where does an endometrial sarcoma arise from?

A

the endometrial stroma

152
Q

which endometrial cancer’s initial presentation may be as metastasis to lung or ovary?

A

endometrial sarcoma

153
Q

what is the most important prognostic factor in endometrial sarcomas?

A

stage is the most important prognostic factor

154
Q

what is the name of the staging criteria used for endometrial and ovarian carcinomas?

A

FIGO staging of endometrial and ovarian carcinomas

155
Q

where is the commonest site of recurrence for endometrial cancer?

A

the vault of the vagina

156
Q

in HNPCC (Lynch syndrome) which cancer are you at highest risk of?

A

colorectal cancer

157
Q

how do many ovarian cancers spread? how does this affect patient presentations?

A

trans-coelomic spread

patients present with GI symptoms/bowel obstruction/ abdominal distension

158
Q

which ovarian tumour produces elevated serum hCG and AFP levels?

A

germ cell tumours

159
Q

which cancers may CEA be raised in?

A

ovarian cancers, especially mucinous tumours

160
Q

what are women who develop CIN more likely to have had?

A

more sexual partners
not used barrier contraception
started having sex at an earlier age

161
Q

in women who are HPV positive, what has shown to increase rusk of CIN/cervical cancer by x4?

A

COCP

162
Q

what is the most common form of cervical cancer?

A

squamous cell carcinoma

163
Q

in the later stages of which cancer may backache, leg pain, haematuria, weight loss, anaemia or changes in the bowel habit be noted?

A

late stage cervical cancer

164
Q

what is the most common subtype of squamous cell cervical cancer?

A

keratinising

165
Q

what is the most common form of spread in cervical cancers?

A

lymphocytic

lymphocytic spread usually results in mets to the pelvic and para aortic nodes

166
Q

what are the chemotherapy drugs often used in cervical malignancies?

A

cisplatin

carboplatin

AA Y4 Finals cards NE (40 decks)

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