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Medicine > Gynaecology > Flashcards

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
Q

Management of SYMPTOMATIC Bartholin’s cyst

A

Marsupialisation: cutting into cyst and placing stiches to make a permanent opening so that the gland can drain freely

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26
Q

What is Turner’s syndrome?

A

Genetic condition where a female has only one X chromosome instead of two

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27
Q

Features of Turner’s syndrome

A

Primary amenorrhoea
Wide, webbed neck
Wide-spaced nipples
Failure to develop secondary sexual characteristics

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28
Q

Aetiology of Cervical Cancer

A

Usually squamous cell carcinoma
Heavily associated w/ persistent human papilloma virus (HPV) infection

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29
Q

Risk factors for cervical cancer

A

HPV 16 and 18 infections
Multiple sexual partners
Smoking
Immunosuppression (e.g. HIV or organ transplants)

30
Q

Clinical features of cervical cancer

A

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
Q

Ix cervical cancer

A

Urgent colposcopy - allows visualisation and biopsy of the cervix
CT chest/abdomen/pelvis is used for cancer staging

32
Q

Mx cervical cancer

A
  • 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
Q

Cervical screening programme

A

24 to 49 = every 3 years
50 to 64 = every 5 years

34
Q

What is endometriosis?

A

condition where endometrial tissue grows outside the uterine cavity

35
Q

Features of endometriosis

A

Dysmenorrhoea (pain around time of period)
- cramping pain
- starts a few days before period
- suprapubic

Dyspareunia

Pelvic Pain

Subfertility

36
Q

Ix endometriosis

A

Laparoscopy: gold standard, carries small risk of complications so not first-line
Trans-vaginal US often normal

37
Q

Mx Endometriosis

A

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
Q

What is Lichen Sclerosis?

A

An inflammatory skin condition affecting the genital and anal areas.
Presents with white patches, which can be itchy and painful

39
Q

Management of lichen sclerosis

A

Topical steroids (very potent: Dermovate)
Avoidance of soaps of the affected areas
Emollients to relieve dryness and itching

40
Q

Threatened miscarriage

A

Mild bleeding, foetus retained within the uterus as cervical os is closed.
Little or no pain
Viable foetus

41
Q

Inevitable miscarriage

A

Heavy bleeding and pain
Foetus currently intrauterine but the cervical os is open
Inevitable foetus will be lost

42
Q

Complete miscarriage

A

All products of conception expelled and uterus is empty
Cervical os usually closed
Patient may have been alerted by pain and bleeding

43
Q

Missed miscarriage

A

uterus still contains foetal tissue, but the foetus is no longer alive
cervical os closed

44
Q

Ix Miscarriage

A

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
Q

Mx Miscarriage

A

Expectant management –> allowing products of conception to naturally expel
Medical management –> misoprostol
Surgical management –> dilation and curettage

46
Q

Medical management for ectopic pregnancy

A

Methotrexate

47
Q

When is surgical management of an ectopic pregnancy indicated?

A

Significant pain
Adnexal mass >35mm
b-hCG level >5000 IU/l
Foetal heartbeat present on US

48
Q

Risk factors for ovarian cancer

A

BRCA1 or BRCA2 mutation
increasing age
FH of ovarian or breast cancer
obesity
smoking
nulliparity
endometriosis

49
Q

Risk associated with lichen sclerosis

A

Developing into vulval cancer if left untreated (5%)

50
Q

Endometrial cancer risk factors

A

nulliparity
obesity
early menarche
late menopause
polycystic ovary syndrome
oestrogen-only hormone replacement therapy

51
Q

Chandelier sign

A

Cervical excitation

  • cervical motion tenderness
  • signs of inflammation of pelvic organs and/or peritoneum
52
Q

Ix if couple has not conceived for 1 year

A

Mid-luteal-phase progesterone and semen analysis

53
Q

Surgical management for a cystocele?

A

Anterior Colporrhaphy

54
Q

What is a cystocele?

A

Bladder prolapse into anterior vaginal wall
–> can cause stress incontinence

55
Q

Contraception and menopause in over 50s

A

use contraception until 1 year after last period

56
Q

Medical management of urge incontinence

A

Oxybutynin

Anticholinergic drugs (e.g. oxybutynin, solifenacin)

57
Q

Surgical management of urge incontinence

A

Botulinum toxin injection

58
Q

Treatment for urge incontinence

A

1st line: behavioural modifications (reduce fluid intake, avoidance of caffeine and alcohol
2nd line: bladder retraining
3rd: Anticholinergic drugs (oxybutynin)
4th: Botulism toxin

59
Q

Treatment for PID?

A

Oral doxycycline, oral metronidazole, intramuscular ceftriaxone

60
Q

Clinical features PID

A

bilateral abdo pain
discharge
post coital bleeding
adnexal tenderness
cervical motion tenderness
fever

RUQ pain (Fitz Hugh Curtis syndrome)

61
Q

What is Fitz Hugh Curtis syndrome?

A

Adhesions form between the anterior liver capsule to the anterior abdominal wall or diaphragm, w/ background of PID.
RUQ pain

62
Q

Most common type of ovarian cyst?

A

Follicular cyst

63
Q

Ruptured ectopic pregnancy treatment

A

Salpingectomy

64
Q

pathophysiology of urge incontinence

A

overactivity of the detrusor muscle

65
Q

What is the most common type of vulvar cancer?

A

Squamous cell carcinomas

66
Q

Most common type of ovarian cancer tumour

A

Epithelial ovarian tumour

67
Q

difference between salpingectomy and salpingostomy

A

Salpingectomy: removal of whole fallopian tube

Salpingostomy: incision into fallopian tube and removal of pregnancy

68
Q

Types of FGM

A

Type 1 - Clitoridectomy
Type 2 - Excision
Type 3 - Infundibulation
Type 4- all other procedures to external genitalia of women for non-medical purposes

69
Q

What is Type 1 FGM

A

Type 1 - Clitoridectomy (partial or total removal of the clitoris)

70
Q

What is Type 2 FGM

A

Type 2 - Excisions (clitoris and labia minora partially or totally removed, with or without excision of labia majora)

71
Q

What is Type 3 FGM

A

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
Q

What is Type 4 FGM

A

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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