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Gynaecology Flashcards

1
Q

What decreases the risk of ovarian cancer

A

COLT

C- children/pregnancy
O- OCP
L- lactation/breastfeeding
T- tubal ligation or hysterectomy

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2
Q

PAP smear result interpretation

A
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3
Q

Ovarian cysts management POSTMENOPAUSAL patient

A

<1cm or equal to = no action
>1cm = USS then and every year

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4
Q

Ovarian cyst management PREMENOPAUSAL patient

A

<3cm = no follow up

> 3 but <5cm repeat USS in 6-12 wks

> 5 but <7cm = repeat USS in 6-12 wks then yearly ff up

> 7cm = Laparoscopy (1st choice) or MRI

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5
Q

BV diagnostic criteria

A
  1. Clue cells on microscopy (Blues clues)
  2. Ph >4.5
  3. Positive whiff test

Also the presence of homogenous thin, white greyish discharge that coats vagina

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6
Q

BV treatment

A
  1. Clindamycin 300mg 12hourly for 7 days
    (1st line in pregnancy)
  2. Metronidazole 400mg 12hourly for 7 days (safe to use as 2nd line treatment in pregnancy)
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7
Q

What is Primary Amenorrhea

A

Absence of menses in 15-16 y/o w/ normal growth and secondary sexual characteristics

OR

Absence of menses in 13-14 y/o w/o normal growth and secondary sexual characteristics

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8
Q

Puberty sequence in GIRLS

A

BGAM

B - reast development/thelarche
G - rowth spurt
A - xilla and pubic hair
M - enstruation (2 yrs fr onset of puberty)

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9
Q

Approach to Primary Amenorrhea

A
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10
Q

Recommended HRT for pts with low risk of endometrial cancer (no uterus) and with a hx of DVT?

A

1st line = Estrogen dermal patch
2nd line = Estrogen implants

*unopposed estrogen is ok if has NO UTERUS

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11
Q

Natural progesterone = no DVT risk but Synthetic progesterone increases DVT risk

True or False

A

True

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12
Q

Dianosis of PMS/PMDD

A

Symptoms have to be present for at least 2 consecutive menstrual cycles

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13
Q

PMS/PMDD management

A

1st line - conservative

2nd line - SSRI

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14
Q

First line antihypertensive in pregnancy

A

Methyldopa

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15
Q

Risk factors for cervical carcinoma

A

PPS I LAV ME

P ersistent HPV infection
P revious cervical ca or screening abnormalities
S moking

I mmunosuppression

L ack of screening
A ge
V (5) or more years of OCP use

M ultiparity
E xposure to DES

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16
Q

Most common cause of vaginal bleeding (especially post coital) in menopausal women

A

Atrophic vaginitis

but still need to exclude other serious causes

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17
Q

Diagnostic test for endometrial cancer

A

Transvaginal USS then biopsy if has endometrial thickening

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18
Q

Cervical ectropion is ____ in postmenopausal women

A

Very uncommon

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19
Q

Contraceptive of choice for women on enzyme-inducing medications

A

Levonorgestrel releasing IUD

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20
Q

Contraindications to IUD use

A

PAGPUPU

P regnancy
A ctive PID or PID within the last 3
months
G enital bleeding of unknown etiology
P ost partum/post abortion endometritis
within the last 3 months
U terine abnormalities/distortion
P revious IUD still in place
U ntreated vaginitis, cervicitis, BV

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21
Q

Common causes of Primary Amenorrhea

A

Most common - Turner Syndrome (no menstruation)
Second most common - Mullerian agenesis (in the presence of normal growth and development in adolescence

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22
Q

Most common pelvic tumor in women younger than 20 years

A

Ovarian teratomas/dermoid cysts

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23
Q

Teratomas appearance on USS

A

Solid mass

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24
Q

The efficacy of Mirena and Depo Provera are not affected by enzyme inducing AEDs

True or False

A

True

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25
Q

AEDs that reduce efficacy of OCPs
(due to drugs being cytochrome p450 inducers causing accelerated clearance of OCPs)

A

C3POT

Carbamazapine
Phenytoin, Phenobarbital, Primidone
Oxcarbazepine
Topiramate

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26
Q

If pt on OCP also needs to be on an enzyme inducing medication?

A

Increase dose of estrogen or use alternative methods (Mirena or Depo Provera)

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27
Q

Absolute contraindication to POP

A

PUBE

Pregnancy
Undiagnosed vaginal bleeding
Breast cancer
Ectopic pregnancy hx or high risk for ectopic pregnancy

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28
Q

Most common symptom of endometriosis

A

Dysmenorrhea

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29
Q

6 hormonal changes in PCOS

A
  1. FSH low or normal
  2. LH high
  3. High LH/FSH ration
  4. Estrogen low or normal
  5. Testosterone high
  6. Prolactin mildly high or normal
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30
Q

How can HRT increase breast cancer risk

A

Use beyond recommended number pf years (3-5 years)

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31
Q

Estrogen only HRT can be used for ___ years before it increases breast cancer risk

A

7

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32
Q

Cervical screening new recommendations (December 2017)

A
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33
Q

First line tx for LS (Lichen Sclerosis)

A

Super potent topical steroid - Clobetasol

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34
Q

Initial investigation for endometriosis

A

Transvaginal ultrasound

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35
Q

First line tx for dysmenorrhea

A

NSAIDS

*OCP is first line if pt requires contraception

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36
Q

Most common symptoms of annovulatory cycle

A

Irregular periods

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37
Q

Investigation of choice for POF/POI

A

FSH (will be elevated), done twice 1 month apart
Estradiol (will be low)

LH is also elevated

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38
Q

S/sx of POF/POI

A

Secondary amenorrhea or menstrual irregularities
Ssx of low estrogen (atrophic vaginitis, decreased libido)

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39
Q

Treatment for atrophic vaginitis

A

estrogen cream

can be used even with personal hx of breast ca, but can only be used in cream form, no systemic estrogen

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40
Q

PCOS triad

A
  1. Clinical or physical hyperandrogenism (hisrsutism, acne, deep voice)
  2. Menstrual dysfunction (irregular or annovulation)
  3. Polycystic ovaries on USS

Only first 2 required for diagnosis
Clinical hyperandrogenism = increased testosterone

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41
Q

Most common cause of irregular heavy menstrual cycles

A

Anovulatory cycles

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42
Q

Most common causes of anovulatory cycles

A

PCOS and approaching menopause

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43
Q

Describe different discharges of STIs (Chlamydia, BV, Trich, Gonorrhea, Candida

A

Chlamydia and Gonorrhea - mucopurulent dc
BV - thin, grey white with fishy odour
Trichomoniasis - thin frithy yellow green with offensive odour
Candida - thich, white, non offensive

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44
Q

What is Raloxifene

A

estrogen receptor modulator

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45
Q

Most common cause of primary infertility

A

Gonadal dysgenesis

Including Turner syndrome

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46
Q

Clinchers for Turner syndrome

A

primary amenorrhea, infertility and short stature

development of breast, axillary and pubic hair does not exclude Turner syndrome as cause

47
Q

Most effective medical therapy for uterine myomas

A

GnRH

48
Q

Only surgical procedure that preserves fertility for pts with fibroids

A

Myomectomy

49
Q

Mgt for pts on COCP then develop HTN

A

switch to POP

If pt is <35 and healthy, non smoker, no ssx of end-organ vascular dse, can stay on COCP with monitoring

50
Q

Management for POF/POI

A

COCP if also needs contraception
Post menopausal HRT if want to have children

51
Q

Management of hot flushes in menopause if has contraindications to HRT

A

Paroxetine (SSRI)

Do not give SSRI with Tamoxifen as it blocks its conversion to its active metabolite - endoxifen

52
Q

COCP reduces which risks to with cancers?

A

CEO
Colorectal
Endometrial
Ovarian

CEO approves COCP

53
Q

Memorise combined and Estrogen only HRT effects on different systems

A
54
Q

Monitoring for pts treated for HSIL

A
55
Q

Treatment for prolactinoma

A

Bromocriptine

56
Q

Advantages of Yasmin

A

Less fluid retention and weight gain

57
Q

LSIL management in pregnancy

A

Same as non pregnant

repeat smear in 12 months (if had normal screening in 2-3 yrs)

58
Q

HSIL management in pregnancy

A

Refer for colposcopy, if no lesion identified, review cytological slides

If HSIL is confirmed on colposcopy, 2nd opinion is recommended
Pregnant women should be reviewed at 20-24 AOG to determine that has no invasive lesion
Definitive mgt for HSIL can be deferred until after pregnancy (given that there are no invasive lesions)

59
Q

Maganement of invasive cervical carcinoma in pregnancy

A

if fetal lungs are mature/near gestaional age of expected lung maturity - deliver (give antenatal corticosteroids if indicated)

If pt decides to terminate pregnancy - start immediate cancer therapy

60
Q

COCP PLUS condoms are indicated in which 4 patient groups

A
  1. <25
  2. > 25 with a new partner
  3. > 25 with 2 or more partners in the last yr
  4. > 25 whose regular partner has multiple partners
61
Q

Define menorrhagia

A

Menstrual periods lasting more than 7 days and with blood loss more than 80 mls

62
Q

2 patterns of AUB (abnormal uterine bleeding)

A
  1. Anovulatory (irregular/unpredictable)
  2. Ovulatory (regular)
63
Q

Causes of ovulatory AUB

A

uterine problems such as (LEAP)
1. leiomyomas
2. endometriosis
3. adenomyosis
4. polyps

64
Q

Causes of anovulatory AUB

A
  1. PCOS
  2. hypo/hyperthyroidism
  3. hyperprolactinemia
  4. Cushing’s syndrome
65
Q

Initial investigations for ovulatory AUB

A

Transvaginal US

66
Q

Endometrial cancer/hyperplasia risk factors

A

CLOUD LINT BEEF

CLOUD (Chronic anovulation, LYNCH, Obesity, Unopposed estrogen, DM)

LINT (Late menopause, Increaseing age, Nulliparity, Tamoxifen)

BEEF (BRCA1/2, Early menarch, estrogen secreting tumors, Family hx of BCEO)

67
Q

Formula for calculation of abstinence period

A
68
Q

Initial management for Bartholin cyst/abscess

A

Word catheter (following I/D)

Also give antibiotics of has sytemic signs of infection

69
Q

Definitive management of Bartholin’s cyst/abscess

A

Excision

Only if all other measures have failed

70
Q

Alternative to word catheter in management of Bartholin’s cyst/abscess

A

Marsupialization

Only if word cathether has failed once or twice

71
Q

Explain Tanner stages

A
72
Q

Contraceptives in the post partum period

TBA

A
73
Q

Best contraceptive for women with menorrhagia

A

Mirena

Levonorgestrel

74
Q

Management for pt’s presenting with ssx of PID

A

Exclude pregnancy
Take cervical swabs for culture

Then give empiric antibiotics

75
Q

Most common sites of endometriosis

A

OPBURBU
Ovaries
Posterior cul-de-sac
Broad ligament
Uterosacral ligament
Rectosigmoid colon
Bladder
Ureter (distal)

Descending order

76
Q

Progesterone has androgenic effect
True or False

A

True

hence contraindicated to pts with PCOS or hyperandrogenism

77
Q

Gold standard for BV diagnosis

A

Gram stain

78
Q

Most common cause of post procedurial PID

A

Vaginal pathogens

79
Q

Most common cause of post-procedual PID in women high risk for STD

A

Vaginal pathogens PLUS Chlamydia

80
Q

Most common cause of PID unrelated to surgical procedure

A

Chlamydia trachomatis

81
Q

Definitive diagnosis of endometriosis is done by

A

Laparoscopy

82
Q

Factors that DECREASES risk for uterine leiomyoma

A

LPGS
Long acting progestogen
Parity
Green vegetables and fruits
Smoking

83
Q

What increases risk for uterine leiomyomas

A

FE SO BP CHF

Family hx of leiomyoma
Early menarche

Significant consumption of red meat
Obesity

Black race
Prenatal exposure to DES

Consumption of alcohol
HTN
Frequent uterine infections

84
Q

Initial investigation for primary amenorrhea PLUS absent secondary sexual characteristics

A

Hormonal assay

85
Q

Initial investigation for primary amenorrhea PLUS present secondary sexual characteristics

A

Pelvic US

86
Q

Breast screening guideline in Australia

A

All asymptomatic women aged 50-69 undergo screening every 2 years

87
Q

What contraceptive is advised for smokers

A

POP

88
Q

Most common indication for hysterectomy

A

Leiomyoma

89
Q

Ligaments that supports the uterus

A

RUBO
round, uterosacral,broad,ovarian

90
Q

Which ligament has the most important role in the pathophysiology of uterine prolapse

A

Uterosacral ligament

91
Q

Next step if colposcopy (following HSIL on screening) is unsatisfactory

A

Cone biopsy

92
Q

Indications for cone biopsy

A

USA
Unsatisfactory colposcopy e.g unable to visualise upper limit of CTZ)
Suspicion of early invasive cancer on cytology
Additional significant glandular abnormality

93
Q

Most effective contraceptive method to reduce pregnancy including ectopic

A

LARS (long acting reversible contraceptive)

94
Q

First line management for PMS/PMDD

A

Non pharmacologic and lifestyle strategies
1. CBT, relaxation
2. Exercise, Vit E, B6, calcium, magnesium

Tx of PMS/PMDD ALWAYS starts with non pharmacological measures for at least 2-3 menstrual cycles

95
Q

Second line management for PMS/PMDD

A

SSRI
Combined new generation pills (Yasmin, Cilest cyclical or continuous)

96
Q

Third line management for PMS/PMDD

A

Estradiol patches
Higher doses of SSRI

97
Q

Fourth line management for PMS/PMDD

A

GnRH antagonist or Danazol

as well as adding HRT to counteract effects of induced estrogen deficiency

98
Q

Main indication of HRT in menopause

A

Vasomotor symptoms - hot flushes

99
Q

Two recommended regimens for combined HRT

A
  1. Cyclical HRT with daily estrogen plus MPA given only for 12 days each month
  2. Continuous therapy with daily estrogen and MPA
100
Q

Explain Cyclical HRT with daily estrogen plus MPA given only for 12 days each month

A

best used with first 1-2 years of cessation of menses, has less unpredictable bleeding caused by progesterone

101
Q

Explain Continuous therapy with daily estrogen and MPA

A

more appropriate 1-2 years after cessation of menses

102
Q

best and most effective method of HRT

A

Estrogen only HRT BUT only if pt has no uterus

unopposed estrogen increases risk of endometrial cancer

103
Q

Recommended contraceptive for pts with otosclerosis

A

IUD

Due to suggestions that COCP can worsen otosclerosis

104
Q

Effects of HRT on different cancers

A

TBA

105
Q

CIs to HRT use

A

APPU
Abnormal vaginal bleeding
Personal hx of breast cancer (not famly hx)
Personal hx or known RF of venous/arterial thromboelmbolic dse inc CVA and CVD
Uncontrolled HTN

106
Q

Treatment for hot flushes when HRT is contraindicated

A

SSRI

Also helps with mood swings but does not help with increasing libido and preserving bone density

107
Q

If HRT is to be given to a pt with hx of thromboembolic dse

A

Use transdermal patches

108
Q

HRT preparation for pts with liver and gallbladder disease

A

Transdermal patches

109
Q

Endometrial cancer is uncommon in premenopausal women and those wiythin first 2-3 yrs of menopause

True or False

A

True

110
Q

Most common cause of secondary amenorrhea

A

Pregnancy

111
Q

First investigation for women in the reproductive age with ammenorrhea

A

Urine pregnancy test

112
Q

Non pharmacological measures for treatment of cyclical mastalgia

A

Wll fitting bra
Compress (warm or ice)
EPO (evening primrose oil)

113
Q

What is Postinor-2

A

Post coital contraception
Contains 2 tablets of Levonborgesreal 750mcg

114
Q

Up to how many hours post coitus must Postinor-2 be taken

A

72 hours

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