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Gynaecology Flashcards

1
Q

Oligomenorrhea

A

infrequent menorrhea

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2
Q

Clinical Features of PCOS

A

Oligomenorrhoea
Subfertility
Acne
Hirsutism
Obesity
Mood swings/depression/anxiety
Male pattern baldness

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3
Q

Ix for PCOS

A

LH:FSH ratio increased (>2)
Total testosterone: normal/slightly raised

Transabdominal and transvaginal ultrasound: shows increased ovarian volume and multiple cysts

Fasting and oral glucose tolerance tests: helps diagnose insulin resistance

Other tests that might be indicated if other pathologies are suspected:
- TFTs (thyroid dysfunction)
- 17-hydroxyprogesterone levels (CAH)
- Prolactin (hyperprolactinaemia)
- DHEA-S and free androgen index (androgen secreting tumours)
- 24-hour urinary cortisol (Cushing’s)

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4
Q

Medical Management of PCOS

A

Pharmacological treatment for women not planning pregnancy

Co-cyprindrol - Useful for reducing hirsutism and inducing regular menstruation.
Combined oral contraceptive pill (COCP) - used to reduce irregular bleeding and protects against endometrial cancer.
Metformin - Helps with menstrual regularity, hirsutism and acne.

Pharmacological treatment for women wishing to conceive

Clomiphene - Induces ovulation and improves conception rates.
Metformin - Can be used with/out clomiphene to increase the chances of a pregnancy.
Ovarian drilling - is a 2nd line laparoscopic surgical procedure where diathermy or laser is used to damage the hormone producing cells of the ovary.
Gonadotrophins - Can induce ovulation if clomiphene and metformin have failed.

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5
Q

What is premature ovarian insufficiency?

A

Menopause in a woman aged below 40

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6
Q

Symptoms of premature ovarian insufficiency?

A

Vasomotor: hot flushes, night sweats
Sexual dysfunction: vaginal dryness, reduced libido, problems with orgasm, dyspareunia
Psychological: depression, anxiety, mood swings, lethargy, reduced concentration

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7
Q

Diagnosis of premature ovarian insufficiency

A

Raised FSH indicates menopause
Has to be repeated at least once to ensure diagnosis

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8
Q

Management of premature ovarian insufficiency

A

HRT until at least age of normal menopause
- unless the risks of HRT outweigh the benefits

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9
Q

Risk factors for endometrial cancer

A

Exposure to unopposed oestrogen, this can be in the form of:
- nulliparity
- obesity
- early menarche
- late menopause
- PCOS
- oestrogen-only hormone replacement therapy (tamoxifen, breast cancer)

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10
Q

Features of endometrial cancer

A

Postmenopausal bleeding
Abnormal vaginal bleeding e.g. intermenstrual bleeding
Dyspareunia
Pelvic pain
Abdo discomfort/bloating
Weight loss
Anaemia

Bi-manual pelvic examination may reveal an enlarged uterus, or may be entirely normal as the gross uterus size may be unchanged

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11
Q

Ix for Endometrial Cancer

A

Bi-manual pelvic examination may reveal an enlarged uterus, or may be entirely normal as the gross uterus size may be unchanged

Transvaginal US is used to look for abnormal thickening of the endometrium
Biopsy of endometrium, obtained via hysteroscopy or pipelle

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12
Q

Management of endometrial cancer

A

Dependent on stage
Limited to the uterus -> hysterectomy w/ bilateral salpingoophorectomy will be curative
Spread outside the uterus -> treatment consists of a combo of surgery, radiotherapy, and chemotherapy

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13
Q

Whirlpool sign on US

A

Ovarian torsion

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14
Q

Name for ovulation cramps

A

Mittelschmerz

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15
Q

When is an ovarian cyst more likely to rupture?

A

During physical activity -e.g. sex, exercise

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16
Q

most commonly used medication for infertility in PCOS

A

Clomifene

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17
Q

Tumour marker for ovarian cancer

A

CA 125

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18
Q

Ovarian cancer features

A

bloating
early satiety
urinary frequency/new onset stress incontinence
abdo discomfort
changes in bowel habits

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19
Q

Causes of post-menopausal bleeding

A

Atrophic Vaginitis (most likely)
Endometrial Cancer (10%)
Endometrial hyperplasia
Cyclical combined HRT (causes regular vaginal bleeding)

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20
Q

Where are the Bartholin’s glands located?

A

Within the vestibule, just lateral to the introitus
One either side of the vaginal opening

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21
Q

Function of Bartholin’s gland

A

Secrete a lubricating fluid (usually during arousal)

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22
Q

Difference between a Bartholin’s gland cyst and abscess

A

Cyst: occurs when the duct gets blocked resulting in a palpable swelling and pain at the site of the Bartholin’s gland
Abscess: occurs when a cyst becomes infected, resulting in extreme pain, lymphadenopathy, erythema

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23
Q

Management of Bartholin’s gland cyst

A

Incision and drainage: under local
Word catheter may also be inserted to promote continued drainage

Abx in cases of abscess

Salt water baths may relieve pain

Surgery may be required in recurrent cases

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24
Q

Most common causative organism of a Bartholin’s cyst

A

E. coli

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25
Management of SYMPTOMATIC Bartholin's cyst
Marsupialisation: cutting into cyst and placing stiches to make a permanent opening so that the gland can drain freely
26
What is Turner's syndrome?
Genetic condition where a female has only one X chromosome instead of two
27
Features of Turner's syndrome
Primary amenorrhoea Wide, webbed neck Wide-spaced nipples Failure to develop secondary sexual characteristics
28
Aetiology of Cervical Cancer
Usually squamous cell carcinoma Heavily associated w/ persistent human papilloma virus (HPV) infection
29
Risk factors for cervical cancer
HPV 16 and 18 infections Multiple sexual partners Smoking Immunosuppression (e.g. HIV or organ transplants)
30
Clinical features of cervical cancer
most cases picked up asymptomatically at cervical screening - vaginal discharge - bleeding (e.g. postcoital or with micturition or defaecation) - vaginal discomfort - urinary or bowel habit change - suprapubic pain - abnormal white/red patches on the cervix - pelvic bulkiness on PV examination - mass felt on PR examination
31
Ix cervical cancer
Urgent colposcopy - allows visualisation and biopsy of the cervix CT chest/abdomen/pelvis is used for cancer staging
32
Mx cervical cancer
- Very small cancers (stage 1A): conisation with free margins to spare fertility - Radical trachelectomy: for slightly more advanced, yet still early-stage cancers when the aim is to spare fertility. Involves removal of the cervix, the upper vagina and pelvic lymph nodes. - Laparoscopic hysterectomy and lymphadenectomy for early-stage w/o need to remain fertile - Radical hysterectomy (uterus, primary tumour, pelvic lymph nodes, sometimes upper 1/3 vagina) for invasive, infiltrating and early metastatic cancer - Spread outside of cervix: radiotherapy/chemotherapy, surgery not curative
33
Cervical screening programme
24 to 49 = every 3 years 50 to 64 = every 5 years
34
What is endometriosis?
condition where endometrial tissue grows outside the uterine cavity
35
Features of endometriosis
Dysmenorrhoea (pain around time of period) - cramping pain - starts a few days before period - suprapubic Dyspareunia Pelvic Pain Subfertility
36
Ix endometriosis
Laparoscopy: gold standard, carries small risk of complications so not first-line Trans-vaginal US often normal
37
Mx Endometriosis
Medical management - analgesia - Hormonal therapies - COCP - Medroxyprogesterone acetate - Gonadotrophin-releasing hormone agonists Surgical Management - diathermy of lesions - ovarian cystectomy - adhesiolysis - bilateral oophorectomy (sometimes w/ hysterectomy) Laparoscopic Ablation of Endometrioid Lesions: reduces pain and improves fertility
38
What is Lichen Sclerosis?
An inflammatory skin condition affecting the genital and anal areas. Presents with white patches, which can be itchy and painful
39
Management of lichen sclerosis
Topical steroids (very potent: Dermovate) Avoidance of soaps of the affected areas Emollients to relieve dryness and itching
40
Threatened miscarriage
Mild bleeding, foetus retained within the uterus as cervical os is closed. Little or no pain Viable foetus
41
Inevitable miscarriage
Heavy bleeding and pain Foetus currently intrauterine but the cervical os is open Inevitable foetus will be lost
42
Complete miscarriage
All products of conception expelled and uterus is empty Cervical os usually closed Patient may have been alerted by pain and bleeding
43
Missed miscarriage
uterus still contains foetal tissue, but the foetus is no longer alive cervical os closed
44
Ix Miscarriage
US: foetal components in uterus or foetal heartbeat Serial hCG measurements 48hrs apart - if level falls --> foetus will not develop or there has been a miscarriage - if only slight increase or a plateau -> may indicate ectopic pregnancy - normal increase -> foetus is growing normally, doesn't rule out ectopic
45
Mx Miscarriage
Expectant management --> allowing products of conception to naturally expel Medical management --> misoprostol Surgical management --> dilation and curettage
46
Medical management for ectopic pregnancy
Methotrexate
47
When is surgical management of an ectopic pregnancy indicated?
Significant pain Adnexal mass >35mm b-hCG level >5000 IU/l Foetal heartbeat present on US
48
Risk factors for ovarian cancer
BRCA1 or BRCA2 mutation increasing age FH of ovarian or breast cancer obesity smoking nulliparity endometriosis
49
Risk associated with lichen sclerosis
Developing into vulval cancer if left untreated (5%)
50
Endometrial cancer risk factors
nulliparity obesity early menarche late menopause polycystic ovary syndrome oestrogen-only hormone replacement therapy
51
Chandelier sign
Cervical excitation - cervical motion tenderness - signs of inflammation of pelvic organs and/or peritoneum
52
Ix if couple has not conceived for 1 year
Mid-luteal-phase progesterone and semen analysis
53
Surgical management for a cystocele?
Anterior Colporrhaphy
54
What is a cystocele?
Bladder prolapse into anterior vaginal wall --> can cause stress incontinence
55
Contraception and menopause in over 50s
use contraception until 1 year after last period
56
Medical management of urge incontinence
Oxybutynin Anticholinergic drugs (e.g. oxybutynin, solifenacin)
57
Surgical management of urge incontinence
Botulinum toxin injection
58
Treatment for urge incontinence
1st line: behavioural modifications (reduce fluid intake, avoidance of caffeine and alcohol 2nd line: bladder retraining 3rd: Anticholinergic drugs (oxybutynin) 4th: Botulism toxin
59
Treatment for PID?
Oral doxycycline, oral metronidazole, intramuscular ceftriaxone
60
Clinical features PID
bilateral abdo pain discharge post coital bleeding adnexal tenderness cervical motion tenderness fever RUQ pain (Fitz Hugh Curtis syndrome)
61
What is Fitz Hugh Curtis syndrome?
Adhesions form between the anterior liver capsule to the anterior abdominal wall or diaphragm, w/ background of PID. RUQ pain
62
Most common type of ovarian cyst?
Follicular cyst
63
Ruptured ectopic pregnancy treatment
Salpingectomy
64
pathophysiology of urge incontinence
overactivity of the detrusor muscle
65
What is the most common type of vulvar cancer?
Squamous cell carcinomas
66
Most common type of ovarian cancer tumour
Epithelial ovarian tumour
67
difference between salpingectomy and salpingostomy
Salpingectomy: removal of whole fallopian tube Salpingostomy: incision into fallopian tube and removal of pregnancy
68
Types of FGM
Type 1 - Clitoridectomy Type 2 - Excision Type 3 - Infundibulation Type 4- all other procedures to external genitalia of women for non-medical purposes
69
What is Type 1 FGM
Type 1 - Clitoridectomy (partial or total removal of the clitoris)
70
What is Type 2 FGM
Type 2 - Excisions (clitoris and labia minora partially or totally removed, with or without excision of labia majora)
71
What is Type 3 FGM
Type 3 - Infundibulation (most extreme, narrowing of the vaginal opening by creating a covering seal. The seal is formed by cutting and repositioning the inner or outer labia, with or without removal of the clitoris)
72
What is Type 4 FGM
Type 4- all other procedures to external genitalia of women for non-medical purposes (pricking, piercing, incising, cauterization)

Medicine (13 decks)

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