Gynaecology👩🏽🤝👩🏻 Flashcards
1
Q
What is definition of Endometriosis?
A
The presence of endometrial tissue outside of the endometrial cavity. e
2
Q
Treatment of Endometriosis?
A
COCP is effective at helping to establish regular periods. GnRH agonists can be used to cause an artificial menopause.
In secondary care, you can have surgery such as ablation.
3
Q
What is adenomyosis?
A
It is endometrial tissue within the myometrium
4
Q
What is Fitz-Hugh-Curtis Syndrome?
A
Occurs when adhesions from between the anterior liver capsule to the anterior abdominal wall or diaphragm on a background of PID. LFTs are often normal.
- Abdo USS should be used to exclude stones
- Laparoscopy is required for definitive diagnosis.
- Treatment is with antibiotics
5
Q
What is the aetiology of endometrial cancer?
A
Obesity, T2DM, Nulliparity, late menopause, oestrogen only HRT, Tamoxifen , pelvic radiation, PCOS, Lynch Syndrome (all unopposed oestrogen)
6
Q
What is the most common pathology of endometrial cancer?
A
Adenocarcinoma
7
Q
What is the aetiology of cervical cancer?
A
High risk HPV, Missed vaccination, early age intercourse, STDs, OCP usage, cigarette smoking, immunosuppression.
8
Q
What is the most common pathology of cervical cancer?
A
Squamous cell carcinoma (90%)
9
Q
Definition of menopause?
A
The cessation of menstruation. It has an average age of 51 years and is diagnosed after 12 months of amenorrhea or onset of symptoms following hysterectomy.
10
Q
Definition of perimenopause?
A
Period leading up to the menopause. Characterised by symptoms such as irregular periods, hot flushes, mood swings etc.
11
Q
Definition of premature ovarian insufficiency?
A
When the menopause occurs <40 years of age. Natural or iatrogenic and can be primary or secondary. It is encouraged that women with premature ovarian insufficiency use HRT until at least the average age of menopause.
12
Q
What is the sign seen on USS in Ovarian Torsion?
A
Whirlpool sign
13
Q
What is the classical presentation of Adenomyosis?
A
Dysmenorrhea menorrhagia and dyspareunia
14
Q
What is the first line treatment of Adenomyosis?
A
If the woman DOES NOT WANT contraception then treatment is used for symptoms control: Tranexamic acid if there is no associated pain and Mefenamic acid if there is associated pain.
If the woman DOES WANT contraception then the mirena coil is first line.
15
Q
What are the signs and symptoms of Lichen Sclerosus?
A
It is small, well defined plaques mainly affecting the external genitals. It is itchy and causes dysuria and dyspareunia.
16
Q
Where is the most common location of an ectopic pregnancy?
A
Most are in the ampulla (97%). Most dangerous location is the isthmus.
17
Q
What is the medical management of an ectopic pregnancy?
A
Methotrexate
18
Q
What is the staging system used in Endometrial cancer?
A
FIGO I/II/III/IV
19
Q
Name some risks of IVF
A
Multiple pregnancy, miscarriage, ectopic pregnancy, ovarian hyperstimulation syndrome
20
Q
What occurs in the follicular phase?
A
1st part of the cycle
- Low oestrogen/progesterone
- Rising levels of FSH
- Developing follicles release oestrogen
- Inhibits FSH
Oestrogen levels then cause positive feedback leading to LH surge and ovulation.
21
Q
What occurs in the luteal phase?
A
- Follicle forms the corpus luteum
- Secretes progesterone
- Peak 7 days after ovulation
-Uness maintained by pregnancy it regresses to corpus albicans
-Falling progesterone causes menstruation
22
Q
Which HRT regimen should be started in a perimenopausal with an intact uterus?
A
Sequential oral/patch
23
Q
Who should have transdermal HRT?
A
Gastric upset, need for steady absorption (migraine/epilepsy), increased risk of VTE, older women, medical conditions e.g., Hypertension.
24
Q
What is the treatment for stress incontinence?
A
Pelvic floor muscle training, surgical procedures
25
What is the treatment of urge incontinence?
Bladder retraining. Bladder stabilising drugs: antimuscarinics are first line (NICE recommends oxybutinin) Mirabegron may be useful if there are concerns about anticholinergics effects in frail elderly patients
26
What conditions cause raised CA125?
Adenomyosis, ascites, ovarian cancer, endometriosis and menstruation as well as breast cancer, ovarian cancer, ovarian torsion, endometrial cancer, liver disease, metastatic lung cancer and many more.
27
What sign would require hospital admission in a patient with PID?
Fever >38C
28
What factors are associated with increased risk of ectopic pregnancy?
Smoking, multiple sexual partners,
use of IUD, prior fallopian tube surgery, infertility and using in vitro fertilisation, age <18 at first sexual intercourse, black race, and age >35 at presentation.
29
What are Nabothian cysts?
- Mucous retention cysts
- Harmless
- More common after childbirth
- Can be left alone
- Cryocautery can be used if they're discharging
30
What is an cervical ectropion?
An area of columnar epithelium extending from the endocervix onto the ectocervix
They are usually asymptomatic but can have heavy discharge, PCB or IMB
Management is to leave them alone but can use electrocautery is symptomatic
31
What HPV types are implicated in cervical carcinoma?
HPV types 16 and 18 are implicated in 90% of cases
32
What is the common histology of cervical cancer?
90% are squamous cell, 10% are adenocarcinoma
33
What lymph nodes can be affected in cervical cancer?
Obturator, Internal, External and Common iliac, para-aortic
34
What are risk factors for uterine fibroids?
Afro Caribbean, obesity, oestrogen sensitive and therefore grow in size with HRT, OCP, and pregnancy
35
What are some risk factors for premature ovarian failure?
FHx, Fragile X, PCOS, Autoimmune disorders, toxin exposure e.g., chemotherapy, radiotherapy, mumps, hysterectomy and smoking
36
What is the Rotterdam criteria?
Diagnostic criteria of PCOS
- Polycystic ovaries on TVUS 12 follicles or
ovarian volume >10ml
o In adolescents don’t need this for dx
- Oligo/amenorrhoea (cycle >42 days)
- Skin changes e.g. acne, hirsutism, alopecia,
male pattern balding or biochemical signs of
hyperandrogenism:
o ^Testosterone
o ^^LH (&FSH)
o Low/normal sex hormone binding globulin
37
What is the medical management of termination less than 9 weeks?
Mifepristone followed by Misoprostol
38
What is the follow up for an individual who has CIN1 with low grade abnormal changes in the transformation zone?
Discharge and follow up in 12 months with potential need for another colposcopy
39
What is the clinical presentation of a missed miscarriage?
- Variable presentation from no symptoms to light vaginal bleeding
- Pregnancy symptoms may decrease
- Cervix is CLOSED
40
What is the clinical presentation of a inevitable miscarriage?
- Vaginal bleeding
- Uterine cramps
- Possible intrauterine fetus with heartbeat
- Cervix is OPEN
41
What is the clinical presentation of an incomplete miscarriage?
- Vaginal bleeding with passage of large clots or tissue
- Uterine cramps
- Products of conception often visualized in dilated cervical os
- Cervix is OPEN
42
What is the clinical presentation of a threatened miscarriage?
- Variable amount of vaginal bleeding
- Pregnancy can proceed to viable birth
- Cervix is CLOSED
43
What is the clinical presentation of a septic miscarriage?
- Fever, malaise, signs of sepsis
- Foul-smelling vaginal discharge, cervical motion and uterine tenderness
- Rarely occurs after spontaneous abortion
- Usually with induced abortions and can be life-threatening
44
How long should a woman taking the COCP/HRT stop it before major surgery?
4 weeks before surgery
45
When is sterilization confirmed?
Vasectomy isn't any immediate form of contraception; semen analysis must be performed and azoospermia confirmed before being used as contraception
46
What would be the blood test findings for a diagnosis of polycystic ovary syndrome?
LH:FSH ratio is increased.
Total testosterone: normal/slightly raised
47
What antibiotics would you give for Pelvic inflammatory disease?
Oral doxycycline, oral metronidazole and IM ceftriaxone
48
What is Marsupialisation?
This is the recommended treatment for symptomatic Bartholin's Cysts. It involves cutting into the cyst and placing stitches to make a permanent opening so that the gland can drain freely.
49
What is the recommended prophylactic surgery for women with BRCA1 mutations
Bilateral salpingooophorectomy
50
What will the USS of a woman with endometriosis be like?
Most likely normal
51
What is the most common ovarian tumour histopathology?
Epithelial cell tumours. They are thought to arise from the lining of the fimbriae in the fallopian tubes.
52
How does cervical screening differ in women with HIV?
As cervical cancer is largely associated with the human papillomavirus (HPV), the immune suppression caused by HIV infection places HIV-positive women at a higher risk of cervical cancer. Therefore for individuals who are HIV positive, annual cervical screening is recommended.
53
How long should smears be delayed for after birth, miscarriages and terminations?
3 months
54
What is the first line management of uterine prolapse?
Vaginal pessary (although sometimes pelvic floor exercises may be tried in mild cases)
55
What cancers does PCOS increase the risk of?
Both endometrial and ovarian cancer but about 2-3x
56
What time of tumour is associated with Meig's syndrome?
Fibromas - a stromal type of benign ovarian tumour
57
What is the first line treatment for Lichen Sclerosus?
A very potent steroid such as Dermovate
58
Why is obesity thought to be a risk factor for endometrial cancer?
It is thought to be due to the proliferation of endometrial stromal cells in response to high insulin levels.
59
Why is obesity thought to be a risk factor for endometrial cancer?
It is thought to be due to the proliferation of endometrial stromal cells in response to high insulin levels.
60
Where is the most common location for vulval cancer?
Labia Majora
61
What is the first line in active management of third stage of labour?
Oxytocin (10IU)
62
What is Asherman's syndrome?
It is characterised by intrauterine adhesions commonly as a result of previous uterine surgery such as dilation and curettage.
It can lead to obstruction to the menstrual outflow tract which presents as secondary amenorrhoea.
62
What is Asherman's syndrome?
It is characterised by intrauterine adhesions commonly as a result of previous uterine surgery such as dilation and curettage.
It can lead to obstruction to the menstrual outflow tract which presents as secondary amenorrhoea.
63
How long is a normal period?
A normal, healthy period should last 4-5 days.
64
What is the name given to painful bowel movements in endometriosis?
Dyschezia
65
What is the third line treatment for endometriosis?
GnRH analogues
Following NSAIDs and/or paracetamol and COCP/POP
66
What are the three components of the Risk of Malignancy index (RMI)?
Ca-125, menopausal status, ultrasound findings.
67
What is RMI?
The RMI is the pre-surgical prognostic criteria recommended by NICE for ovarian cancer, and is based on CA125 levels, menopausal status, and ultrasound score.
68
Why does chlamydia put you at increased risk of ectopic pregnancy?
Chlamydia can cause scarring of the fallopian tubes and subfertility. This is because any pathology that slows the egg's passage to the uterus can lead to an increased risk of ectopic pregnancy
68
Why does chlamydia put you at increased risk of ectopic pregnancy?
Chlamydia can cause scarring of the fallopian tubes and subfertility. This is because any pathology that slows the egg's passage to the uterus can lead to an increased risk of ectopic pregnancy
69
Which increased your risk of breast cancer more, combined HRT or oestrogen only HRT?
Combined HRT (adding a progestogen increases the risk)
69
Which increased your risk of breast cancer more, combined HRT or oestrogen only HRT?
Combined HRT (adding a progestogen increases the risk)
69
Which increased your risk of breast cancer more, combined HRT or oestrogen only HRT?
Combined HRT (adding a progestogen increases the risk)
70
What definition is used to classify bleeding as 'abnormally heavy'?
An amount that the woman considers to be excessive
70
What definition is used to classify bleeding as 'abnormally heavy'?
An amount that the woman considers to be excessive
71
What non-HRT medications can you use to manage vasomotor symptoms of menopause?
Fluoxetine, citalopram or venlafaxine
72
What is the surgical treatment for a postmenopausal woman with atypical endometrial hyperplasia and why?
A total hysterectomy with bilateral salpingo-oophorectomy.
Due to the increased risk of malignant progression.
72
What is the surgical treatment for a postmenopausal woman with atypical endometrial hyperplasia and why?
A total hysterectomy with bilateral salpingo-oophorectomy.
Due to the increased risk of malignant progression.
73
What is stage 1 ovarian cancer?
Tumour confined to the ovary
74
What is stage 2 ovarian cancer?
Tumour outside ovary but within pelvis
75
What is stage 3 ovarian cancer?
Tumour outside the pelvis but within the abdomen
76
What is stage 4 ovarian cancer?
Distant metastasis
77
What is the best imaging technique for diagnosing adenomyosis?
MRI pelvis
78
What is the most suitable surgical option for vaginal vault prolapse?
Sacrocolpopexy.
This procedure suspends the vaginal apex to the sacral promontory
79
What is associated with a decreased incidence of hyperemesis?
Smoking
80
When is admission indicated for nausea and vomiting in pregnancy?
- Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics
- Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics
- A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)
81
What triad should be present before a diagnosis of hyperemesis gravidarum?
- 5% pre-pregnancy weight loss
- Dehydration
- Electrolyte imbalance
82
What complications may result from hyperemesis gravidarum?
- Wernicke's encephalopathy
- Mallory-Weiss tear
- Central pontine myelinolysis
- Acute tubular necrosis
- Fetal : small for gestational age, pre-term birth
83
When might Duloxetine be used in stress incontinence?
Duloxetine may be used in patients with stress incontinence who don't respond to pelvic floor muscle exercises and decline surgical intervention
83
When might Duloxetine be used in stress incontinence?
Duloxetine may be used in patients with stress incontinence who don't respond to pelvic floor muscle exercises and decline surgical intervention
84
What should you do in infertility services if a semen sample is abnormal?
Repeat the test ideally 3 months later
85
What is the most common benign ovarian tumour in women under the age of 30 years?
Dermoid cyst also called mature cystic teratomas.
86
What is the most common site of lymphatic spread in ovarian cancer?
Para-aortic lymph nodes
87
What is the most common site of haematological spread in ovarian cancer?
Liver
88
What score can be used to classify the severity of nausea and vomiting in pregnancy
Pregnancy-unique quantification of emesis (PUQE)
89
Which ovarian tumour is associated with the development of atypical hyperplasia of the endometrium?
Granulosa cell tumours
90
Which ovarian tumour is associated with the development of atypical hyperplasia of the endometrium?
Granulosa cell tumours
91
What are the three features of Meig's syndrome?
A benign ovarian mass, ascites, pleural effusion
92
When switching from a traditional POP to COCP how many days of barrier contraception is needed?
7 days of barrier contraception is needed
93
How long before the IUD becomes effective?
Instantly
94
If a tumour of the ovary contains "signet ring" cells, which types of cancer should be screened for?
Krukenberg tumours of the ovary refer to a tumour containing "signet ring" vells. This is typically a gastrointestinal carcinoma which has metastasised to the ovary
95
What are some features of ovarian neoplasms?
- Hirsutism due to testosterone secretion
- Acute abdomen due to ovarian torsion
- Rupture or haemorrhage
- Thyrotoxicosis as in struma ovarii
- Amenorrhoea
96
What is haematocolpos?
An accumulation of blood in the vagina, usually due to an imperforate hymen
97
What is Ovarian hyperthecosis?
It accounts for most cases of hyperandrogenaemia in post-menopausal women.
It describe the presence of luteinised theca cell nests in the ovarian stroma.
98
Which structure provides the major support to the uterus and cervix?
The Cardinal ligaments
99
What are some common manifestations of PMS?
Abdo bloating, weight gain, constipation, anxiety, breast tenderness, depression, cravings for sugar or salt and irritability
100
Where are gonadotropins produced?
Anterior pituitary
101
What are some risk factors for Pelvic Inflammatory disease?
- Multiple sexual partners (increases risk by 5fold)
- IUD/IUS is risk factor in the first 3 weeks after placement
- Previous PID
- Frequent vaginal douching (increases risk by 3fold)
102
Which non-malignant adnexal mass is derived from all three germ cell layers?
Mature cystic teratomas (dermoids)
103
Which theories could be used to explain endometriosis?
1) Retrograde menstruation (viable endometrial cells reflux through the tubes during menstruation and implant in the pelvis)
2) Celomic metaplasia (multipotential cells of the celomic epithelium are stimulated to transform into endometrium-like cells)
3) Haematogenous dissemination (endometrial cells are transported to distant sites)
4) Autoimmune disease (a disorder of immune surveillance that allows ectopic endometrial implants to grow)
104
What does simple cystometry look at?
Involves placing a catheter and gradualling filling with sterile water. Looks at:
- stress incontinence
- detrusor overactivity
- measurement of first sensation to void
- bladder capacity
105
What is the karyotype for partial hydatidiform moles?
69XXX Karyotype
106
What is the hormone best used as a measurement of ovarian reserve?
Anti-Müllerian hormone (AMH) levels can be measured in blood and are shown to be proportional to the number of small antral follicles. Serum AMH levels decrease with age and are undetectable in the post-menopausal period. AMH levels represent the quantity of the ovarian follicle pool and are a useful marker of ovarian reserve.
107
What are the five stages of female puberty?
1) Growth spurt
2) Breast development
3) Pubic hair growth
4) Menstruation
5) Axillary hair growth
108
If you are suspecting Ovarian cancer and you have a raise CA-125, what is the next investigation?
US abdo pelvis
109
If FSH and LH are abnormally high where is the problem?
Ovary or testes
110
If FSH and LH are low where is the lesion?
Pituitary or Hypothalamus
111
What is Adrenarche?
The onset of growth of pubic hair
112
What is Thelarche?
The development of the breast bud
113
What are some red flags for a patient with heavy menstrual bleeding?
- Age>40
- Intermenstrual bleeding
- Endometrial thickness (ET) >10mm in a premenopausal woman
- Fibroids or polyps
114
What percentage of uterine fibroids undergo malignant change?
0.1%
115
What is the most common presentation of endometrial cancer and what risk does this carry?
Postmenopausal bleeding is the most common and qualifies a 10% risk of carcinoma
116
What is the lifetime risk of developing ovarian cancer?
1 in 48 women
117
What factors make it more likely than an ovarian mass is malignant?
Ascites
Bilateral masses
Solid or septate nature on ultrasound scan
Rapid growth
Increased vascularity
118
What are some epidemiological points about vulval carcinoma?
- Carcinoma of the vulva accounts for 5% of genital tract cancers
- There are up to 1,000 new cases each year in the UK
- Most common after the age of 60
119
What are some risk factors for prolapse?
Multiparity
Oestrogen deficiency
Raised BMI
Ovarian cyst
Chronic cough
120
What is dyschezia and in what condition is it seen?
Pain on defaecation, can be seen in endometriosis
121
How does the COCP act?
Acts mainly by exerting a negative feedback effect on gonadotrophin release and thereby inhibiting ovulation
