Gynaecology Flashcards
What is the whirlpool sign a sign of?
Ovarian torsion
Pharmacological treatment for PCOS infertility
Clomifene
How often do women aged 25-49 attend for a cervical smear
every 3 years
what site of ectopic pregnancy increases the risk of rupture
isthmus
What is the most common ovarian cancer
serous carcinoma
medical treatments for endometroosis
NSAIDs
COCP
GnRH analogues
4 classic symptoms of endometriosis
pelvic pain
dysmenorrhoea
dyspareunia
subfertility
first line treatment for primary dysmenorrhoea
NSAIDs e.g. mefenamic acid
diagnosis of mild pain in pregnancy
threatened miscarriage
most common identifiable cause of postcoital bleeding
cervical ectropion
When do you measure mid luteal progesterone when fertility testing
7 days before the end of the cycle (day 21)
pharmacological management of stress incontinence
duloxetine
pharmacological treatment for ovulation induction to treat fertility
letrozole
if a semen sample is abnormal then when should a repeat test be arranged?
3 months later
Diagnosis in patients with continuous dribbling incontinence after prolonged labour from an area with limited obstetric services
Vesicovaginal fistulae
Medical management of miscarriage
Give vaginal misoprostol alone
Cause of post menopausal bleeding
Granulosa cell tumours
What is the best measure of ovulation
Progesterone 7 days before
What are women with PCOS at increased risk of?
Ovarian hyperstimulation syndrome
What does PCOS increase the risk of?
Endometrial cancer
Patient with secondary dysmenorrhoea
Refer to gynae for invesitgation
Pharmacological management and clinical diagnosis of bacterial vaginosis
Strawberry cervic
Oral metronidazole
Pharmacological management of gram negative gonorrhoea
IM ceftriaxone
What can smoking help with in pregnancy (but obvs don’t do it lol)
Sickness
Investigation for adenomyosis
MRI
Investigation for recurrent thrush
Diabetes
Medical abortion at any gestation
Mifepristone followed by at least one episode of prostaglandins
Pharmacological management of PMS
SSRI during the luteal phase
Downside of adding a progesterone to HRT
Increases the risk of breast cancer
What is Rokitansky’s protuberance
Dermoid cyst (teratoma)
What does endometriosis increase the risk of?
Ectopic pregnancy
Pharmacological management to reduce the size of uterine fibroids
GnRH agonists e.g. triptorelin
Strong risk factor for endometrial cancer
HNPCC/Lynch Syndrome
What would you do if a cervical smear sample was inadequate
Repeat the smear in 3 months
What would you do if HPV was abnormal but the cells were normal
Repeat the test in 12 months then:
- if normal HPV then discharge to regular screening
- If abnormal HPV then repeat again 12 months later and if still abnormal then colposcopy
What would you do if the HPV and cells were abnormal on a smear?
Refer to colposcopy
First line for non pregnant women with vaginal thrush
how does it present?
Single dose oral fluconazole
creamy white odourless discharge
When can you give an IUS for heavy periods in a female with a fibroid?
If the fibroid is less than 3cm
Multi-loculated ovarian cyst with strong blood flow - management
Refer for biopsy, high suspicion of malignancy
Known cause of fertility (e.g. PCOS) when would you refer to fertility services?
What treatment would they recieve?
Immediately
Clomifene or metformin 1st line then laparoscopic ovarian drilling or gonadotrophins
Widely spaced nipples, systolic murmur and primary amenorrhoea - diagnosis and 1st line investigation to prove it
Turners Syndrome
Increased FSH/LH
Cervical ectopion
Post coital bleeding, excessive discharge, pregnant and previously took the COCP
Cervical ectropion
Increased columnar epithelium
Mechanism of action of oxybutynin and what is it used for
Anti muscarinic for overactive bladder
Most common type of ovarian pathology associated with Meigs’ syndrome
What 2 things is it associated with?
Fibroma
Associated with ascites and pleural effusion
Most common benign ovarian tumour in women under the age of 25 years
Dermoid cyst (teratoma)
Most common cause of ovarian enlargement in women of a reproductive age
Follicular cyst
Is migraine with aura a contraindication for HRT?
No
Patient with LMP over 12 months ago with some recent vaginal bleeding, HRT?
Contraindicated, needs further investigation
Menopausal lady with hot flushes who does not want HRT
Fluoxetine for vasomotor Sx
Older lady with labial lump and inguinal lymphadenopathy
Vulval carcinoma
Unilateral labial swelling with pain whilst walking and dysparapeunia in a woman of childbearing age
Bartholians Cyst
Treatment for vaginal vault prolapse
Sacrocolpopexy
Chronic pelvic and sacral pain with menstruation, tender posterior vaginal fornix with uterine motion tenderness
Endometriosis
Gold standard investigation for endometriosis
Laparoscopy
How does ovarian cancer initially spread?
Local spread within the pelvic region
then to the abdomen
Investigation for continuous dribbling incontinence
Urinary dye studies
Diagnosis of PCOS
2/3 of the following:
Infrequent or no ovulation
Clinical or biochemical signs of hyperandrogenism or elevated levels of total or free testosterone
Polycystic ovaries on ultrasonography or increased ovarian volume
Snow storm appearance on ultrasound
Complete hyadtidiform mole
MOA of metformin in PCOS
Increases peripheral insulin sensitivity
Women who are HIV positive, how often should they attend a cervical smear?
Annual cervical cytology
Management of patient with secondary amenorrhoea
All patients with secondary dysmenorrhoea need to be referred to gynaecology for investigation
What are the three components of the RMI for ovarian cancer?
US findings, menopausal status and CA125 levels
Ovarian cyst that if ruptures may cause pseudomyxoma peritonei
Mucinous cystadenoma
The most common type of epithelial cell tumour
Serous cystadenoma
Ovarian cyst that may contain skin appendages, hair and teeth
Dermoid cyst (teratoma)
What increases the risk of hyperemesis gravidarum
Multiple pregnancy
For how many weeks after terination is the HCG positive
4 weeks
First line pharmacological management of nausea and vomiting in pregnancy
Prochlorperazine
How long after pregnancy do you have to wait until you have a smear test
3 months post-partum unless missed screening or previous abnormal smears
