Gynaecology Flashcards by Aureliah K

Name 4 risk factors for a prolapse

Prolonged 2nd stage labour
Instrumental delivery
Menopause
multiple vaginal delvieries
Older age
Obesity
chronic cough
chronic constipation

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Name 4 symptoms of a prolapse

Heavyness
dragging sensation
urinary sx - frequency / urgency
bowel sx - constipation / incontinence
sexual dysfucntion - dysparerunia

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What are the examination findings in a patient with a prolapse

Abdominal exam
Bimanulal exam - protrusion
- Ask patient to cough or bear down
- stress incontinence

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Outline the management of a prolpase

Conservative
- Weight loss
- Pelvic floor exercises
- mx chronic risk factors

Medical
- Pessary
- vaginal oestrogen protects vaginal walls from irritation
Surgical repair

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Name 5 risk factors for stress and urge urinary inconteinence

Urge
- high BMI
- Recurrent UTIs
- Older age
- Smoking

Stress
- Post childbirth
- Instrumental delivery
- Prolonged 2nd stage delivery
- Post hysterectomy
- Older age
- Prolapse
- Post-menopausal

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What is stress incontinence

An increase in intrabdominal pressure leads to urine leakage due to weak pelvic floor

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What investigations are required for incontinence

Urien dipstick and culture - infection / haematuria
Vaginal examination - R/O prolpase
Bladder diary
Urodynamic studies

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What is the management of stress

1st - Keegle exercises / weight loss / reduce caffeine intake/ smoking cessation

2nd - Duloxetine / Burch cloposuspension

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How is urge incontienence managed

1st line - bladder retraining

2nd line - Antimuscarinic
- Oxybutinin
- Tolteradine

3rd line - Botulinium toxin

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Give 3 causes of delayed puberty

Athlete
ED
Chronic disease

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How does ovarain torsion present - Sx and signs

Twisting of ovary on ligamentous supports - typically due to ovarian mass

Sudden onset Colicky abdominal pain
N+V
Fever

Adnexal tenderness and mass

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How is ovarian torsion investigated and managed

1st line - TVUS - Whirlpool sign
2nd line - Doppler studies
Diagnostic and theraputic - Laparoscopy

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What investigations are required in acute pelvic pain

Urinalysis + MSU
Pregnancy test
FBC / CRP / TFT / LFT
HVS + ECV
TVUS

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What is a follicualr cyst

commonest ovarian cyst
non-rupture of dominant follicle
regresses after several menstrual cycles

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Name to physiological cysts

Follicular
Corpus luteum

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Name 3 pathological cysts

Endometrioma
PCO - ring of pearls
Theca luteum cyst - occurs in conditions with high B-Hcg

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Name 3 benign epithelial neoplastic cysts

Epithelial - common in post menopausal women
serous cystadenoma
mucinous cystadenoma
Brenner

Germ cell - dermoid
Assosciated with torsion
Rokitansky protuberence

sex cord stromal - fibroma
Meigs syndrome

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Name 4 sx assosciated with ovarian cysts

Asx
Dull ache abdominal pain
Dyspareunia
Irregular vaginal bleeding
bloating
fullness in abdomen

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Name 4 Ix when suspecting ovarian cysts

Pregnancy test
Bloods
- FBC / Ca125
TVUS
Laparoscopy - diagnsotic

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What additional blood tests are required in women <40 with an ovarian cyst

Teratoma
- LDH
- AFP
- HcG
- Inhibin

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Name 4 causes of raised Ca125

Endometriosis
Ovarian cancer
Fibroids
Adenomyosis
Pregnancy

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What indicates a 2ww referral in patients with an ovarian cyst

complex cysts
raised Ca125

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What is endometreosis

Ectopic growth of endometrial tissue outside of uterine cavity

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Name 4 common sites for endometriosis

Uterosacral ligaments
On ovaries
Pouch of douglas

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Name 4 risk factors for endometreosis

early menarche late menopause nuliparity FHx

Name 2 protective factors for endometreosis

multiparity COCP

Name 4 sx of endometreosis

Cyclical pelvic pain Secondary dysmenorrhoea - pain starts before bleeding subfertility dyspareunia urgency dyschezia

Describe signs / examianiton findings on a patient with endometreosis

endometrial tissue visible - posterior fornix fixed retroverted uterus tenderness in vagina / cervix / adexna

What investigations are required in endometriosis

TVUS - Endometrioma / chocolate cysts Laparoscopy + biopsy - diagnostic

Outline the management of endometriosis

C - Fluids / exercise M - 1st line - NSAIDs / paracetamol Not wanting to conceive - COCP / POP / Depot / Implant / Mirena / GnRH agonist S - Not wanting to conceive - Hysterectomy + salpino-oophrectomy wanting to conceive - Laparoscopy + adhesiolysis

What causes infertility in endometreosis

adhesions tubal + ovarian dysfunction oocyte toxicity

How do hormonal treatments manage endometriosis?

Stops ovulation and reduce endometrial thickening

What is a fibroid

Benign smooth muscle tumour of uterus

Name 4 RF for fibroids

Early menarche / Late menopause Afro-caribbean Obesity Perimenopausal FHx Increasing age

Name 3 protective factors for fibroids

POP Pregnancy Late puberty

Name 4 sx of fibroids

Dysmenorrhoea Menorrhagia Deep Dyspareunia Subfertility Frequency / Urgency Blaoting and feeling of fullness

Name signs / examination findings of fibroids

Irregular shaped Firm Non-tender Enlarged

Outline the management of fibroids

Not wanting to conceive - IUS - COCP - Injectable progesterone - myomectomy - uterine artery embolisation Wanting to conceive - NSAIDs - Tranexamic acid - ablation - hysterectomy

What is adenomyosis

Growth of endometrial tissue in myometrium - more common in multiparous - women > 40

Name 3 sx of adenomyosis

Dysmenorrhoea menorrhagia dysparerunia Infertility

What is found on examination of adenomyosis

Bimanual - large, tender boggy uterus

What Investigations are required for a patient with suspected adenomyosis

TVUS MRI - if TVUS not suitable Hysterectomy + histology - gold standard

What is PID

Inflammation and infection of organs in pelvis caused by ascending spread of infection up through the cervix

Name 3 causes for PID

Chlamydia Gonorrhoea Mycoplasma genitalium Gardenella vaginalis

Name 4 RF for PID

No barrier contraception multiple sexual partners early age of intercourse IUD Previous PID Younger age Existing STI

How does PID present - sx

Chronic pelvic pain abnormal vaginal discharge IMB / PCB Dysparerunia Fever Dysuria

What examination findings are present in PID

Pelvic tenderness vaginal discharge cervicitis cervical excitation

What investigations are required in a patient with suspected PID

NAAT - Gonorrhoea / chlamydia NAAT - Mycoplasma genitalium HIV Syphilis HVS Pregnancy test Bloods - FBC / CRP

Outline the different strains of HPV and what they cause

6+11 - genital warts 16+18 - cancer

What other cancers does HPV cause

cervical anal vulval penile throat mouth

Name 3 protective factors for ovarian cancer

COCP Parity Breastfeeding Early menopause

Name 4 sx of ovarian cancer

Bloating abdominal distension abdominal pain early satiety change in bowel habit urinary sx - urgency

What is the diagnostic investigation

Laparoscopy

Name 5 RF for endometrial cancer

Unopposed oestrogen tamoxifen Obesity DM PCOS Early menarche Nuliaprity late menopause

Name 2 protective factors for endometrial cancer

COCP Multiparity

What are the presenting sx of endometrial cancer

PMB Pre menopausal - Menorrhagia / IMB

What are the parameters for a 2ww referal for endometrial cancer

> 55 y/o + PMB

What are the age ranges for cervical cancer scrrening

every 3 years: 25 - 49 every 5 years: 50-64

Name 4 RF for cervical cancer

COCP Early first intercourse multiple sexual partners HIV Smoking high parity

Describe the staining used for colposcopy

Acetic acid - abnormal cells appear white Iodine test - health cells stain brown and abnormal cells do not stain

What is the most common form of cervical cancer

SCC Adenocarcinoma - rising as screening identifies more SCC

What are the sx of cervical cancer

PCB / IMB / PMB Discharge Dyspareunia

What is ectopion

Eversion of columnar epithelium of cervix

Name 3 RF for ectropion

Pregnancy COCP Puberty

Name 4 features of PCOS

Infertility Oligomenorrhoea Hirsturism Acne Obesity Acanthosis nigricans

What investigations are required in a patient with suspected PCOS

Bloods - Raised LH:FSH - raised serum testosterone - low sex hormone binding globulin TVUS

What criteria is used in PCOS

Rotterdam criteria - Oligomenorrhoea - Serum or phsyical signs of high testosterone - TVUS >12 Antral follicles Ovarian volume > 10

Name 4 complications of PCOS

DM CVD Endometrial cancer OSA Depression

What are some sx of a polyp

Menorrhagia Discharge PCB IMB

Name 3 causes of PMB

Cancer Polyp HRT Trauma Vaginal atrophy

What are the sx of atrophic vaginitis

vaginal dryness dysparerunia PCB Polyuria Nocturia

Name 4 signs of atrophic vaginitis

decrease pubic hair lack of vaginal folds pale mucosa thin skin dry Painful examination