Gynaecology Flashcards
Enlarged ‘boggy’ uterus
Adenomyosis
Mx. Adenomyosis
Hysterectomy
Hypothalamic amenorrhoea may be caused by:
Stress, anorexia and excessive exercise
Androgen insensitivity syndrome mode of inheritance:
X-linked recessive
Symptoms suggestive of ectopic pregnancy and > 6 weeks gestation:
Urgent referral to early pregnancy service
Symptoms suggestive of atopic pregnancy and < 6 weeks gestation:
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
Most cervical cancers are what kind of carcinoma:
Squamous cell (80%)
other 20% are adenocarcinoma
Delay of cervical screening postpartum:
3 months
Treatment of CIN
Large loop excision of transformation zone (LLETZ)
Cryotherapy
Stage 1A cervical cancer treatment:
Cone biopsy - will preserve fertility
Stage IB, II, III cervical cancer tx.
Radiation w/ concurrent chemotherapy
Complications of radiotherapy in cervical cancer
Diarrhoea, vaginal bleeding, radiation burns, pain on micturition
Long-term: Ovarian failure, fibrosis of bowel/skin/bladder/vagina
Uterus size greater than expected for dates:
Complete hydatidiform mole
Primary dysmenorrhoea tx.
NSAIDS such as mefanamic acid and ibuprofen - effective in 80%
COCP used second line
Management of secondary amenorrhoea
Refer ALL patients to gynaecology for investigation
Abdominal tenderness, cervical excitation and adnexal mass
ECTOPIC pregnancy
1st line investigation in suspected ectopic pregnancy:
Transvaginal ultrasound
HNPCC is a risk factor for which female cancer
Endometrial cancer
Endometrial cancer tx.
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
Management of simple endometrial hyperplasia without ATYPIA
High dose progestogens w/ repeat sampling in 2-3 months. IUS may be used
Management of simple endometrial hyperplasia WITH ATYPIA
Hysterectomy
Management for endometriosis
NSAIDs and paracetamol first line
COCP second-line
Non gynaecological symptoms of endometriosis
Urinary: dysuria, urgency, frequency, haematuria
Dyschezia - painful bowel movements
Endometriosis: If analgesia/hormonal treatment doesn’t work:
GnRH analogues - induce pseudomenopause
Fibroid degeneration presentation:
Low-grade fever, pain and vomiting
PID: Peri-hepatic inflammation secondary to chlamydia:
Fitz-Hugh Curtis syndrome)
Menorrhagia primary investigation:
Trans-vaginal ultrasound
FBC
short term medication to rapidly terminate heavy menstrual bleeding:
Norethisterone
When is hyperemesis gravidarum most common:
8-12 weeks
May persist up to 20 weeks
Hyperemesis gravidarum
first-line tx.
Second line tx.
Oral CYCLIZINE or promethazine
Ondansetron and metoclopramide (should not be used for more than 5 days)
Admissions may be needed for IV hydration
Long term complications of hysterectomy:
Enterocele and vaginal vault prolapse
Infertility investigations: Serum progresterone -> when should it be tested
7 days prior to next expected period (Day 21 in a regular 28 day cycle)
Key counselling points for infertility:
Folic acid
Aim for both partners BMI 20-25
Advise regular intercourse every 2-3 days
smoking/drinking advice
Contraindications to HRT:
Current or past breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
Non HRT management of menopausal symptoms:
Vasomotor symptoms:
Fluoxetine, citalopram or venlafaxine
Commonest type of ovarian cyst:
Follicular cyst
Benign ovarian germ cell tumours:
Dermoid cyst - most common benign ovarian tumour in women < 30 years
Benign ovarian epithelial tumours:
Serous cystadenoma
Mucinous cystadenoma
Serous cystadenoma = most common benign epithelial tumour
Mucinous cystadenoma = Second most common
Typically massive and may cause pseudomyxoma peritonea
Imaging in ovarian cysts:
Ultrasound
Ultrasound free fluid - Whirlpool sign:
Ovarian torsion
Ovarian torsion management:
Laparoscopy is both diagnostic and therapeutic
Ovarian tumours: psammoma bodies
Serous cystadenocarcinoma
Most common Ovarian germ cell cancer
Dysgerminoma
Other term for teratoma:
Dermoid cysts (most common germ cell tumour)
Schiller-Duval bodies on histology and increased AFP
Yolk-sac tumour
Sex-cord stromal tumours: often produce
Hormones
3 sex-cord stromal tumours:
Which of these if malignant
Granulosa cell tumour (MALIGNANT)
Sertoli-Leydig
Fibroma
Granulosa cell tumour produces:
Excess oestrogen
Sertoli-leydig tumour produces:
Androgens -> masculinising effects
associated w. Peutz-Jeghers syndrome
Name for ovarian tumour which metastasises from a GI primary
Kruckenberg tumour
Most common cause of pelvic inflammatory disease:
Chlamydia trachomatis
Other causes:
Neisseria Gonorrhoea
Mycoplasma genitalum
Mycoplasma hominis
Pelvic inflammatory disease mx.
Oral OFLOXACIN + oral METRONIDAZOLE
or
IM CEFTRIAXONE + oral DOXYCYCLINE + oral METRONIDAZOLE
PCOS investigations:
Pelvic ultrasound
FSH, LH, Prolactin, TSH and testosterone.
Raised LH:FSH ratio is classical
Check for impaired glucose tolerance
Premature ovarian insufficiency mx.
HRT or COCP should be offered to women until menopause age (51 yrs)
Management of premenstrual syndrome:
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
How long should bladder retraining last in urge incontinence :
Minimum 6 weeks
Alternative for urge incontinence for older people at risk of anti-cholinergic side-effects from Oxybutinin
MIRABEGRON - b3 agonist
Prolapse management: Cystocele/cystourethrocele
Anterior colporrhaphy or colposuspension
Prolapse management: Uterine prolapse
Hysterectomy or sacrohysteropexy
Prolapse management: rectocele
Posterior colporrhaphy
Vaginal candidiasis mx:
If oral therapy contraindicated
If pregnant
Oral fluconazole 150 mg as single dose first-line
Clotrimazole 500 mg vaginal pessary
Only topical preparations can reused in pregnancy
Asymptomatic fibroids tx.
No treatment needed other than periodic review and monitor size and growth.
