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MSRA exam > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What is the definition of primary amenorrhoea?

A

Failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development), or by 13 years of age in girls with no secondary sexual characteristics

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2
Q

What is the definition of secondary amenorrhoea?

A

cessation of menstruation for 3-6 months in women with previously normal and regular menses, or 6-12 months in women with previous oligomenorrhea

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3
Q

Name 3 cause of primary amenorrhoea:

A

Gonadal dysgenesis (Turner’s syndrome)
Congenital malformation of the genital tract
Congenital Adrenal Hyperplasia
Imperforate Hymen
Functional hypothalamic amenorrhoea (secondary to anorexia)

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4
Q

Name 3 causes of secondary amenorrhoea: (after pregnancy)

A

PCOS
Premature ovarian failure
Sheehan syndrome
Asherman’s syndrome
Hypothalamic amenorrhoea (eg secondary to stress or exercise)

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5
Q

What will happen to FSH and LH in premature ovarian failure?

A

high

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6
Q

What will happen to androgen levels in PCOS?

A

They’ll rise.

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7
Q

How do you treat primary amenorrhoea secondary to Turner’s syndrome?

A

HRT

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8
Q

How does the vagina appear in atrophic vaginitis?

A

Pale and dry

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9
Q

What is the first and second-line treatment for atrophic vaginitis?

A
  1. Lubricants and moisturisers
  2. Topical oestrogen cream
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10
Q

What is the main type of cervical cancer?

A

Squamous Cell Carcinoma

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11
Q

What are some symptoms of cervical cancer?

A

Vaginal bleeding (PC, IMB, PMB)
Vaginal discharge
Urinary sx

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12
Q

Name 5 RF for cervical cancer:

A

HPV virus
COCP
high parity
HIV
Smoking

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13
Q

When do people get called for cervical cancer screening in the UK ?

A

25-49 every 3 years
50-64 every 5 years.

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14
Q

When do you do cervical screening on a pregnant lady?

A

Wait till they are 3 months post partum or had previous abnormal smears (think does this need to be done in pregnancy)

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15
Q

When is the best time in a cycle to take a smear?

A

Mid cycle

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16
Q

What happens when a cervical screening sample is negative for HPV?

A

Return to normal recall

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17
Q

What happens to a negative HPV result after TOC?

A

Invite for a repeat in 6 months

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18
Q

What happens if it’s HPV +ve and there are abnormal cells?

A

Colposcopy

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19
Q

What happens if +ve HPV but normal cytology?

A

Repeat test in 12 months

If that test is negative return to normal recall

If repeat test is still +ve further repeat at 12 months and then if +ve again colposcopy.

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20
Q

What happens if a cervical screening sample is inadequate?

A

repeat the sample in 3 months

If two inadequate samples do colposcopy.

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21
Q

What is the first line treatment for primary dysmenorrhoea?

A

Mefenamic Acid

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22
Q

Second line treatment for primary dysmenorrhoea?

A

COCP

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23
Q

4 causes of secondary dysmenorrhoea?

A

Adenomyosis
Endometriosis
PID
IUD (copper)
Fibroids

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24
Q

Two conditions that give you cervical excitation?

A

PID
Ectopic pregnancy

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25
3 RF for ectopic pregnancy
PID (damages the tubes) Previous ectopic endometriosis Copper Coil IVF
26
What are the 3 ways to manage an ectopic pregnancy?
1. Expectant <35mm 2. Medical <35mm 3. Surgical if >35mm
27
3 reasons why you might do surgical management on an ectopic pregnancy?
foetal heart beat size >35mm pain HCG >5000
28
What does expectant management in ectopic pregnancy mean?
You wait 48hrs if B HCG rises or new symptoms then medical or surgical intervention is indicated
29
What does medical management of an ectopic pregnancy involve?
Methotrexate (only if they agree to come for follow up)
30
What are 3 RF for endometrial cancer?
Early menarche Late menopause Nullparity Tamoxifen PCOS DM
31
WHat is the first line investigation for endometrial cancer?
Transvaginal US Then do a hysteroscopy with endometrial biopsy
32
What are two protective factors for endometrial cancer?
Smoking COCP
33
What is a gold standard investigation for endometriosis?
Laparoscopy
34
What are the first and second line treatments for endometriosis?
1. NSAIDs 2. COCP
35
First line treatment for heavy bleeding in those wanting contraception:
Mefenamic Acid
36
First line treatment for heavy PV bleeding in those who want contraception
IUS COCP
37
Name 3 SE of HRT
weight gain nausea breast tenderness
38
What are 3 impacts of HRT
increased risk of breast cancer increased risk of endometrial cancer increased risk of VTE
39
3 associations with hyperemesis gravidarum
multiple pregnancies trophoblastic disease null parity obesity
40
Name 3 situations when you would consider admission into hospital for hyperemesis gravidarum..
Ketones in urine Weight loss >5% Unable to keep down oral liquids or anti emetics
41
What is the first line management of hyperemesis gravidarium ?
Oral cyclizine Ondansetron
42
In people being investigated for infertility when should you test their progesterone levels?
For a typical 28 day cycle do it day 21. On others take it 7 days prior to the expected next period.
43
what does a progesterone >30 suggest
indicates ovulation
44
When does the average woman go through the menopause?
51
45
When is it recommended to use effective contraception until if aged >50 and <50
>50 12 months <50 24 months
46
3 contraindications to HRT.
Breast cancer Unexplained vaginal bleeding Untreated endometrial hyperplasia
47
What is the order of the 4 parts of the menstrual cycle?
1. Menstruation 2. Follicular Phase 3. Ovulation 4. Luteal phase
48
What causes ovulation?
The acute release of LH.
49
What happens to body temperature after ovulation?
It rises
50
Up until what week is it classed as a miscarriage?
24 weeks
51
3 reasons why medical miscarriage mx would be used
increased risk of haemorrhage previous trauma associated evidence of infection
52
What is the medical management for a miscarriage?
Vaginal misoprostol
53
What is the most common form of ovarian cancer ?
Serous cell
54
Name 4 RF of ovarian cancer
Family history: mutations of the BRCA1 or the BRCA2 gene early menarche, late menopause, nulliparity
55
2 investigations for ovarian cancer
Ca125 if abnormal for US abdomen
56
What is the most common type of physiological cyst?
Follicular Cysts
57
Is a simple or complex cyst associated with malignancy?
Complex cysts
58
What do you do with a simple cyst in under 30 yr olds?
If the cyst is small (e.g. < 5 cm) and reported as 'simple' then it is highly likely to be benign. A repeat ultrasound should be arranged for 8-12 weeks and referral considered if it persists.
59
How do you treat PID?
intramuscular ceftriaxone + oral doxycycline + oral metronidazole
60
What is Fitz-Hugh Curtis Syndrome?
Associated with PID. When you get RUQ commonly misinterpreted as cholecystitis
61
4 RF for vulval carcinoma
Human papilloma virus (HPV) infection Vulval intraepithelial neoplasia (VIN) Immunosuppression Lichen sclerosus
62
How do you treat vaginal thrush?
oral fluconazole 150 mg as a single dose first-line clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated
63
Would you do a uterine artery embolisation in a patient who wanted to become pregnant?
No
64
What is the management of urge incontinence?
bladder retraining
65
What is the management of stress incontinence?
pelvic floor muscle training
66
What medication do you use for urge incontinence?
antimuscarinics are first-line NICE recommend oxybutynin
67
What medication do you use for stress incontinence?
duloxetine may be offered to women if they decline surgical procedures
68
How do you terminate a pregnancy less than 9 weeks?
less than 9 weeks: mifepristone (an anti-progestogen, often referred to as RU486) followed 48 hours later by prostaglandins to stimulate uterine contractions
69
How do you terminate a pregnancy at less than 13 weeks?
surgical dilation and suction of uterine contents
70
How do you terminate a pregnancy at more than 15 weeks
more than 15 weeks: surgical dilation and evacuation of uterine contents or late medical abortion (induces 'mini-labour')

MSRA exam (16 decks)

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