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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
Q

3 RF for ectopic pregnancy

A

PID (damages the tubes)
Previous ectopic
endometriosis
Copper Coil
IVF

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26
Q

What are the 3 ways to manage an ectopic pregnancy?

A
  1. Expectant <35mm
  2. Medical <35mm
  3. Surgical if >35mm
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27
Q

3 reasons why you might do surgical management on an ectopic pregnancy?

A

foetal heart beat
size >35mm
pain
HCG >5000

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28
Q

What does expectant management in ectopic pregnancy mean?

A

You wait 48hrs if B HCG rises or new symptoms then medical or surgical intervention is indicated

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29
Q

What does medical management of an ectopic pregnancy involve?

A

Methotrexate (only if they agree to come for follow up)

30
Q

What are 3 RF for endometrial cancer?

A

Early menarche
Late menopause
Nullparity
Tamoxifen
PCOS
DM

31
Q

WHat is the first line investigation for endometrial cancer?

A

Transvaginal US

Then do a hysteroscopy with endometrial biopsy

32
Q

What are two protective factors for endometrial cancer?

A

Smoking
COCP

33
Q

What is a gold standard investigation for endometriosis?

A

Laparoscopy

34
Q

What are the first and second line treatments for endometriosis?

A
  1. NSAIDs
  2. COCP
35
Q

First line treatment for heavy bleeding in those wanting contraception:

A

Mefenamic Acid

36
Q

First line treatment for heavy PV bleeding in those who want contraception

A

IUS
COCP

37
Q

Name 3 SE of HRT

A

weight gain
nausea
breast tenderness

38
Q

What are 3 impacts of HRT

A

increased risk of breast cancer
increased risk of endometrial cancer
increased risk of VTE

39
Q

3 associations with hyperemesis gravidarum

A

multiple pregnancies
trophoblastic disease
null parity
obesity

40
Q

Name 3 situations when you would consider admission into hospital for hyperemesis gravidarum..

A

Ketones in urine
Weight loss >5%
Unable to keep down oral liquids or anti emetics

41
Q

What is the first line management of hyperemesis gravidarium ?

A

Oral cyclizine
Ondansetron

42
Q

In people being investigated for infertility when should you test their progesterone levels?

A

For a typical 28 day cycle do it day 21.

On others take it 7 days prior to the expected next period.

43
Q

what does a progesterone >30 suggest

A

indicates ovulation

44
Q

When does the average woman go through the menopause?

A

51

45
Q

When is it recommended to use effective contraception until if aged >50 and <50

A

> 50 12 months
<50 24 months

46
Q

3 contraindications to HRT.

A

Breast cancer
Unexplained vaginal bleeding
Untreated endometrial hyperplasia

47
Q

What is the order of the 4 parts of the menstrual cycle?

A
  1. Menstruation
  2. Follicular Phase
  3. Ovulation
  4. Luteal phase
48
Q

What causes ovulation?

A

The acute release of LH.

49
Q

What happens to body temperature after ovulation?

A

It rises

50
Q

Up until what week is it classed as a miscarriage?

A

24 weeks

51
Q

3 reasons why medical miscarriage mx would be used

A

increased risk of haemorrhage
previous trauma associated
evidence of infection

52
Q

What is the medical management for a miscarriage?

A

Vaginal misoprostol

53
Q

What is the most common form of ovarian cancer ?

A

Serous cell

54
Q

Name 4 RF of ovarian cancer

A

Family history: mutations of the BRCA1 or the BRCA2 gene
early menarche, late menopause, nulliparity

55
Q

2 investigations for ovarian cancer

A

Ca125
if abnormal for US abdomen

56
Q

What is the most common type of physiological cyst?

A

Follicular Cysts

57
Q

Is a simple or complex cyst associated with malignancy?

A

Complex cysts

58
Q

What do you do with a simple cyst in under 30 yr olds?

A

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
Q

How do you treat PID?

A

intramuscular ceftriaxone + oral doxycycline + oral metronidazole

60
Q

What is Fitz-Hugh Curtis Syndrome?

A

Associated with PID. When you get RUQ commonly misinterpreted as cholecystitis

61
Q

4 RF for vulval carcinoma

A

Human papilloma virus (HPV) infection
Vulval intraepithelial neoplasia (VIN)
Immunosuppression
Lichen sclerosus

62
Q

How do you treat vaginal thrush?

A

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
Q

Would you do a uterine artery embolisation in a patient who wanted to become pregnant?

A

No

64
Q

What is the management of urge incontinence?

A

bladder retraining

65
Q

What is the management of stress incontinence?

A

pelvic floor muscle training

66
Q

What medication do you use for urge incontinence?

A

antimuscarinics are first-line
NICE recommend oxybutynin

67
Q

What medication do you use for stress incontinence?

A

duloxetine may be offered to women if they decline surgical procedures

68
Q

How do you terminate a pregnancy less than 9 weeks?

A

less than 9 weeks: mifepristone (an anti-progestogen, often referred to as RU486) followed 48 hours later by prostaglandins to stimulate uterine contractions

69
Q

How do you terminate a pregnancy at less than 13 weeks?

A

surgical dilation and suction of uterine contents

70
Q

How do you terminate a pregnancy at more than 15 weeks

A

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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