Gynaecology Flashcards
Name 4 risk factors for a prolapse
Prolonged 2nd stage labour
Instrumental delivery
Menopause
multiple vaginal delvieries
Older age
Obesity
chronic cough
chronic constipation
Name 4 symptoms of a prolapse
Heavyness
dragging sensation
urinary sx - frequency / urgency
bowel sx - constipation / incontinence
sexual dysfucntion - dysparerunia
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
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
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
What is stress incontinence
An increase in intrabdominal pressure leads to urine leakage due to weak pelvic floor
What investigations are required for incontinence
Urien dipstick and culture - infection / haematuria
Vaginal examination - R/O prolpase
Bladder diary
Urodynamic studies
What is the management of stress
1st - Keegle exercises / weight loss / reduce caffeine intake/ smoking cessation
2nd - Duloxetine / Burch cloposuspension
How is urge incontienence managed
1st line - bladder retraining
2nd line - Antimuscarinic
- Oxybutinin
- Tolteradine
3rd line - Botulinium toxin
Give 3 causes of delayed puberty
Athlete
ED
Chronic disease
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
How is ovarian torsion investigated and managed
1st line - TVUS - Whirlpool sign
2nd line - Doppler studies
Diagnostic and theraputic - Laparoscopy
What investigations are required in acute pelvic pain
Urinalysis + MSU
Pregnancy test
FBC / CRP / TFT / LFT
HVS + ECV
TVUS
What is a follicualr cyst
commonest ovarian cyst
non-rupture of dominant follicle
regresses after several menstrual cycles
Name to physiological cysts
Follicular
Corpus luteum
Name 3 pathological cysts
Endometrioma
PCO - ring of pearls
Theca luteum cyst - occurs in conditions with high B-Hcg
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
Name 4 sx assosciated with ovarian cysts
Asx
Dull ache abdominal pain
Dyspareunia
Irregular vaginal bleeding
bloating
fullness in abdomen
Name 4 Ix when suspecting ovarian cysts
Pregnancy test
Bloods
- FBC / Ca125
TVUS
Laparoscopy - diagnsotic
What additional blood tests are required in women <40 with an ovarian cyst
Teratoma
- LDH
- AFP
- HcG
- Inhibin
Name 4 causes of raised Ca125
Endometriosis
Ovarian cancer
Fibroids
Adenomyosis
Pregnancy
What indicates a 2ww referral in patients with an ovarian cyst
complex cysts
raised Ca125
What is endometreosis
Ectopic growth of endometrial tissue outside of uterine cavity
Name 4 common sites for endometriosis
Uterosacral ligaments
On ovaries
Pouch of douglas
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