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4th year passmed > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Enlarged ‘boggy’ uterus

A

Adenomyosis

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2
Q

Mx. Adenomyosis

A

Hysterectomy

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3
Q

Hypothalamic amenorrhoea may be caused by:

A

Stress, anorexia and excessive exercise

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4
Q

Androgen insensitivity syndrome mode of inheritance:

A

X-linked recessive

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5
Q

Symptoms suggestive of ectopic pregnancy and > 6 weeks gestation:

A

Urgent referral to early pregnancy service

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6
Q

Symptoms suggestive of atopic pregnancy and < 6 weeks gestation:

A

if NO pain or risk factors for ectopic, they can be managed expectantly:
Repeat urine pregnancy test after 7-10 days and return if positive

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7
Q

Most cervical cancers are what kind of carcinoma:

A

Squamous cell (80%)

other 20% are adenocarcinoma

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8
Q

Delay of cervical screening postpartum:

A

3 months

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9
Q

Treatment of CIN

A

Large loop excision of transformation zone (LLETZ)

Cryotherapy

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10
Q

Stage 1A cervical cancer treatment:

A

Cone biopsy - will preserve fertility

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11
Q

Stage IB, II, III cervical cancer tx.

A

Radiation w/ concurrent chemotherapy

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12
Q

Complications of radiotherapy in cervical cancer

A

Diarrhoea, vaginal bleeding, radiation burns, pain on micturition

Long-term: Ovarian failure, fibrosis of bowel/skin/bladder/vagina

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13
Q

Uterus size greater than expected for dates:

A

Complete hydatidiform mole

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14
Q

Primary dysmenorrhoea tx.

A

NSAIDS such as mefanamic acid and ibuprofen - effective in 80%
COCP used second line

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15
Q

Management of secondary amenorrhoea

A

Refer ALL patients to gynaecology for investigation

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16
Q

Abdominal tenderness, cervical excitation and adnexal mass

A

ECTOPIC pregnancy

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17
Q

1st line investigation in suspected ectopic pregnancy:

A

Transvaginal ultrasound

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18
Q

HNPCC is a risk factor for which female cancer

A

Endometrial cancer

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19
Q

Endometrial cancer tx.

A

Total abdominal hysterectomy w/ bilateral salpingo-oophorectomy
Pts. w/ high risk disease may receive post op RADIOTHERAPY

Progestogen therapy for old, frail women who are not candidates for surgery

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20
Q

Management of simple endometrial hyperplasia without ATYPIA

A

High dose progestogens w/ repeat sampling in 2-3 months. IUS may be used

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21
Q

Management of simple endometrial hyperplasia WITH ATYPIA

A

Hysterectomy

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22
Q

Management for endometriosis

A

NSAIDs and paracetamol first line

COCP second-line

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23
Q

Non gynaecological symptoms of endometriosis

A

Urinary: dysuria, urgency, frequency, haematuria

Dyschezia - painful bowel movements

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24
Q

Endometriosis: If analgesia/hormonal treatment doesn’t work:

A

GnRH analogues - induce pseudomenopause

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25
Q

Fibroid degeneration presentation:

A

Low-grade fever, pain and vomiting

26
Q

PID: Peri-hepatic inflammation secondary to chlamydia:

A

Fitz-Hugh Curtis syndrome)

27
Q

Menorrhagia primary investigation:

A

Trans-vaginal ultrasound

FBC

28
Q

short term medication to rapidly terminate heavy menstrual bleeding:

A

Norethisterone

29
Q

When is hyperemesis gravidarum most common:

A

8-12 weeks

May persist up to 20 weeks

30
Q

Hyperemesis gravidarum
first-line tx.
Second line tx.

A

Oral CYCLIZINE or promethazine
Ondansetron and metoclopramide (should not be used for more than 5 days)

Admissions may be needed for IV hydration

31
Q

Long term complications of hysterectomy:

A

Enterocele and vaginal vault prolapse

32
Q

Infertility investigations: Serum progresterone -> when should it be tested

A

7 days prior to next expected period (Day 21 in a regular 28 day cycle)

33
Q

Key counselling points for infertility:

A

Folic acid
Aim for both partners BMI 20-25
Advise regular intercourse every 2-3 days
smoking/drinking advice

34
Q

Contraindications to HRT:

A

Current or past breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia

35
Q

Non HRT management of menopausal symptoms:

Vasomotor symptoms:

A

Fluoxetine, citalopram or venlafaxine

36
Q

Commonest type of ovarian cyst:

A

Follicular cyst

37
Q

Benign ovarian germ cell tumours:

A

Dermoid cyst - most common benign ovarian tumour in women < 30 years

38
Q

Benign ovarian epithelial tumours:

A

Serous cystadenoma
Mucinous cystadenoma

Serous cystadenoma = most common benign epithelial tumour

Mucinous cystadenoma = Second most common
Typically massive and may cause pseudomyxoma peritonea

39
Q

Imaging in ovarian cysts:

A

Ultrasound

40
Q

Ultrasound free fluid - Whirlpool sign:

A

Ovarian torsion

41
Q

Ovarian torsion management:

A

Laparoscopy is both diagnostic and therapeutic

42
Q

Ovarian tumours: psammoma bodies

A

Serous cystadenocarcinoma

43
Q

Most common Ovarian germ cell cancer

A

Dysgerminoma

44
Q

Other term for teratoma:

A

Dermoid cysts (most common germ cell tumour)

45
Q

Schiller-Duval bodies on histology and increased AFP

A

Yolk-sac tumour

46
Q

Sex-cord stromal tumours: often produce

A

Hormones

47
Q

3 sex-cord stromal tumours:

Which of these if malignant

A

Granulosa cell tumour (MALIGNANT)
Sertoli-Leydig
Fibroma

48
Q

Granulosa cell tumour produces:

A

Excess oestrogen

49
Q

Sertoli-leydig tumour produces:

A

Androgens -> masculinising effects

associated w. Peutz-Jeghers syndrome

50
Q

Name for ovarian tumour which metastasises from a GI primary

A

Kruckenberg tumour

51
Q

Most common cause of pelvic inflammatory disease:

A

Chlamydia trachomatis

Other causes:
Neisseria Gonorrhoea
Mycoplasma genitalum
Mycoplasma hominis

52
Q

Pelvic inflammatory disease mx.

A

Oral OFLOXACIN + oral METRONIDAZOLE
or
IM CEFTRIAXONE + oral DOXYCYCLINE + oral METRONIDAZOLE

53
Q

PCOS investigations:

A

Pelvic ultrasound
FSH, LH, Prolactin, TSH and testosterone.
Raised LH:FSH ratio is classical
Check for impaired glucose tolerance

54
Q

Premature ovarian insufficiency mx.

A

HRT or COCP should be offered to women until menopause age (51 yrs)

55
Q

Management of premenstrual syndrome:

A

Lifestyle advice (small regular meals rich in complex carbohydrates)

Moderate symptoms may benefit from new generation COCP

Severe symptoms = SSRI (taken continuously or just during the luteal phase

56
Q

How long should bladder retraining last in urge incontinence :

A

Minimum 6 weeks

57
Q

Alternative for urge incontinence for older people at risk of anti-cholinergic side-effects from Oxybutinin

A

MIRABEGRON - b3 agonist

58
Q

Prolapse management: Cystocele/cystourethrocele

A

Anterior colporrhaphy or colposuspension

59
Q

Prolapse management: Uterine prolapse

A

Hysterectomy or sacrohysteropexy

60
Q

Prolapse management: rectocele

A

Posterior colporrhaphy

61
Q

Vaginal candidiasis mx:
If oral therapy contraindicated
If pregnant

A

Oral fluconazole 150 mg as single dose first-line
Clotrimazole 500 mg vaginal pessary

Only topical preparations can reused in pregnancy

62
Q

Asymptomatic fibroids tx.

A

No treatment needed other than periodic review and monitor size and growth.

4th year passmed (28 decks)

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