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Med Finals - Womens Health > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Define primary amenorrhoea

A

Not starting menstruation:
By 13 when there is no evidence of pubertal development
By 15 when there are signs of puberty - breast bud development

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2
Q

Define androgen insensitivity

A

Condition where the tissues are unable to respond to androgen hormones so male sexual characteristcs do not develop - results in femal phenotype wo

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3
Q

Define secondary amenorrhoea

A

Defined as no menstruation for more than 3 months after previous regular menstrual periods.

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4
Q

Causes of secondary amenorrhoea

A

Pregnancy!
Menopause
Premature ovarian failure
Hormonal contraception
Hypothalamic or pituiraty pathology
Polycystic ovarian syndrome
Asherman’s syndrome - uterine pathology
Thyroid pathology
Hyperprolactinaemia

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5
Q

Management of hyperprolactinaemia

A

Dopamine agonists - cabergoline

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6
Q

Presentation of premenstrual syndrome

A

Low mood
Anxiety
Mood swings
IRritability
Bloating
Fatigue
Headaches
Breast pain
Reduced confidence
Cognitive impairment
Clumsiness
Reduced liibido

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7
Q

Define menorrhagia

A

Heavy menstrual bleeding - >80ml
Changing pads 1-2 hours, lasting more than 7 days, passing large clots,

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8
Q

Causes of menorrhagia

A

Dysfunctional uterine bleeding
Extremes of reproductive age
Fibroids
Endometriosis
PID
Contraceptive - copper coil
Anticoagulation
Bleeding disorders
Endocrine disorders
Connective tissue disorders
Endometrial hyperplasia
Cancer
PCOS

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9
Q

Management of menorrhagia

A

Tranexamic acid
Mefenamic acid

Mirena coil
COCP
Cyclical progesterone

Ablation
Hysterectomy

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10
Q

Define fibroids

A

Benign tumours of the smooth muscle of the uterus - common, oestrogen sensitive

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11
Q

Types of fibroids

A

Intramural - within myometrium
Subserosal - just below outer layer of uterus (grow outwards and can become very large)
Submucosal - just below lining of the uterus endometrium
Pedunculated - on a stalk

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12
Q

Presentation of fibroids

A

Menorrhagia
Prolonged menstruation
Abdominal pain
Bloating
Urinary or bowel symptoms - increased pressure
Deep dyspareunia
Reduced fertility
Palpable pelvic mass

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13
Q

Investigations in fibroids

A

Hysteroscopy
Pelvic ultrasounds
MRI scan

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14
Q

Management of fibroids

A

<3 cm - mireena, symptomatic control, COCP, cyclical progesterone, endometrial ablation, resection, hysterectomy

> 3cm - mirena, COCP, POP, uterine artery embolisation, myomectomy, hysterectomy

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15
Q

Define endometriosis

A

A condition where there is sctopic endometrial tissue outside the uterus.

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16
Q

Presentation of endometriosis

A

Cyclical abdominal pelvic pain
Deep dydpareunia
Dysmenorrhoea
Infertility
Cyclical bleeding from other sites
Urinary symptoms
Bowel symptoms

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17
Q

Investigations in endometriosis

A

Pelvic ultrasound
Laparoscopic exploration - gold standard

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18
Q

Management of endometriosis

A

Analgesia - NSAIDS
Hormonal management - COCP, POP, Mirena,
Laparoscopy
Hysterectomy

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19
Q

Define adenomyosis

A

Refers to endometrial tissue inside the myometrium - common in older multiparous women.

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20
Q

Presentation of adenomyosis

A

Dysmenorrhoea
Menorrhagia
Dyspareunia
Infertility
Complications in pregnancy

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21
Q

Investigations in adenomyosis

A

Transvaginal ultrasound
MRI
Histological examination - post hysterectomy

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22
Q

Management of adenomyosis

A

Tranexamic acid
Hormonal control
Uterine artery ablation
Hysterectomy

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23
Q

Complications in pregnancy of adenomyosis

A

Infertility
Miscarriage
Preterm birth
Small for gestational age
Preterm rupture of membranes
Malpresentation
C section
Post partum haemorrhage

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24
Q

Define menopause

A

Point at which menstruation stops - no periods for 12 months

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25
Define premature menopause
Menopause occuring becfore the age of 40 - results from premature ovarian insufficiency
26
Perimenopausal smptoms
Hot flushes Emotional lability Low mood Premenstrual syndrome Irregular periods Joint pains Heavier or lighter periods Vaginal dryness and atrophy Reduced libido
27
Management of perimenopausal symptoms
No treatment HRT Clonidine CBT SSRI Testosterone Vaginal oestrogen Tibolone - steroid acts as continuous HRT Vaginal moisturisers
28
Define premature ovarian insufficiency
Define as menopause before the age of 40 - results from the decline in the normal activity of the ovaries
29
Causes of premature ovarian failure
Idiopathic Iatrogenic - oophrectomy Autoimmune - coeliac, adrenal, TIDM, thyroid disease Genetic - turner's syndrome Infections - mumps, tuberculosis, cytomegalovirus
30
Presentation of premature ovarian failure
Irregular menstrual periods Low oestrogen levels Perimenopausal symptoms
31
Management of premature ovarian failure
HRT
32
When is progesterone given in HRT
When women still have a uterus - require protection from endometrial hyperplasia and cancer - unopposed oestrogen
33
Non-hormonal management of perimenopausal symptoms
Lifestyle CBT Clonidine SSRI Venlafaxine Gabapentin
34
Risks of HRT
Increased risk of Breast and endometrial cancer VTE Stroke Coronary artery disease
35
Contraindications to HRT
Abnormal bleeding Endometrial hyperplasia or cancer Breast cancer Uncontrolled hypertension Venous thromboembolism Liver diseae Active angina or MI Pregnancy
36
Types of HRT available
Oestrogen only or combined with progesterone Cyclical or continuous Local or systemic
37
Define poly cystic ovarian syndrome
Common condition causing metabolic and reproductive problems in women - multiple ovarian cysts, infertility, oligomenorrhea, hyperandrogenism and insulin resistance
38
Define anovulation
Absence of ovulation
39
Define oligoovulation
Irregular infrequent ovulation
40
Define amenorrhoea
Absence of menstrual periods
41
Define oligomenorrhoea
Irregular or infrequent periods
42
Define hirsutism
Growth of thick dark hair often in a male pattern - facial hair
43
What is the criteria for PCOS diagnosis
Rotterdam criteria Oligoovulation or anovulation Hyperandrogenism - hirsutism, acne Polycystic ovaries on ultrasound.
44
Presentation of PCOS
Oligomenorrhoea or amonorrhoea Infertility Obesity Hirsutism Acne Hair loss in male pattern Insulin resistance and diabetes Acanthosis nigricans CVD Hypercholesterolaemia Endometrial hyperplasia and cancer Obstructive sleep apnoea Depression and anxiety Sexual problems
45
Investigations in PCOS
Testosterone, sex hormone-binding globulin, FSH, Prolactin, thyroid stimulating hormone High LH compared to DSH Pelvic ultrasound - 12 or more developing follicles, ovarina volume >10 cm3
46
Management of PCOS
Lifestyle - prevent diabetes Fertility Hirsutism and acne
47
Define ovarian torsion
Condition where the ovary twists in relation to the surrounding connective tissue, fallopian tube and blood supply
48
Presentation of ovarian torsion
Sudden onset seveere unilateral pain Nausea an vomiting Localised tenderness and palpable mass
49
Investigations in ovarian torsion
Ultrasound - whirlpool sign Laparoscopic exploration
50
Management of ovarian torsion
Laparoscopic surgery - untwist or removal
51
Define Asherman's syndrome
Where adhesions form within the uterus following damage - usually after pregnancy
52
Presentation of Asherman's syndrome
Secondary amenorrhoea Lighter periods Dysmenorrhoea
53
Investigations in asherman syndrome
Hysteroscopy Hysterosalpingography Sonohysterography MRI
54
Management of ashermans syndrome
Dissection of adhesion during hysteroscopy
55
Define cervical ectropion
When columnar epithelium of the endocervix extends out to the ectocervix, becomes visible and easily iritated
56
Presentation of cervical ectropion
Increased vaginal discharge Vaginal bleeding Dyspareunia Postcoital bleeding Well-demarcated border between redder, velvety columnar epithelium extending from the os vs the pale pink squamous epithelium of the ectocervix
57
Management of cervical ectropion
No treatment required Problematic bleeding can be cauterised
58
Risk factors for prolapse
Multiple vaginal deliveries Instrumental prolonged or traumatic delivery Advanced age Postmenopausal status Obesity Chronic respiratory condition - coughing Chronic constipation - straining
59
Presentation of prolapse
Sense of something coming down Dragging sensation Urinary symptoms - incontinence, urgency, frequency, weak stream, retention Bowel symptoms - constipation, incontinence, urgency Sexual dysfunction Identified lump
60
Management of prolapse
Conservative - physio, weight loss, lifestyle Pessary Surgery - mesh repairs.
61
Define urge incontinence
Caused by overactivity of the detrusor muscle of the bladder. Feel sudden urge to pass urine.
62
Define stress incontinence
Weakness of the pelvic floo and sphincter muscle allows urine to leak at times of high pressure - laughing, coughing, jumping.
63
Risk factors for incontinence
Increase age Postmenopausal Increased BMI Previous pregnancies Vaginal deliveries Prolapse Pelvic floor surgery Neuro conditions - MS Cognitive impairment
64
Investigations in incontinence
Bladder diary Dip stick Post void residual volume Urodynamic testing
65
Management of stress incontinence
Avoid caffeine Avoid excessive fluid Weight loss Pelvic floor exercises Surgery Duloxetine
66
Management of urge incontinence
Bladder retraining Anticholinergics - oxybutinin Mirabegron Surgery - botox,
67
Define atrophic vaginitis
Refers to dryness and atrophy of the vaginal mucosa related to lack of oestrogen - occurs when entering the menopause
68
Presentation of atrophic vaginitis
Itching Dryness Dyspareunia Bleeding due to localised inflamamtion Recurrent UTI Stress incontinence Pelvic organ prolapse
69
Management of atrophic vaginitis
Lube Oestrogen creams
70
Define lichen sclerosus
Chronic inflammatory condition that presents with atches of shiny "porcelain-white" skin - commonly affecting labia, perineum and perianal skin in women.
71
Presentation of lichen sclerosus
Itching Soreness Skin tightness or changes Painful sex - superficial Erosions Fissures
72
Management of lichen sclerosus
Topical steroids Emollients

Med Finals - Womens Health (10 decks)

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