Gynaecology Flashcards
PCOS medications
a) for regular cycle , acne and hirtuism
b) to induce ovulation
a) Metformin , COCP , CO-pyrindrol
b) Clomifene = induces ovulation and improves conception rates
Endometriosis symptoms
diagnosis ?
- endometrial tissue outside the uterus
+ chronic pelvic pain
+ heavy menstrual periods
+ infertility
+irregular bleeding
+ dyspareunia = pain during sex
diagnosis = laparoscopy
heavy bleeding + pain ( everything is normal )
treatment
Mefenamic acid
PCOS criteria
Rotterdam Criteria :
- Oligo or an ovulation
- hyperandrogensim
- clinical or biochemical polycystic ovaries on USS
Treatment for PID
- Cover chlamydia - doxycycline
- Cover Gonorrhoea- IM ceftriaxone
- Cover BV - metronidazole
or Ofloxacin + metronidazole
staging for endometrial cancer and risk factors
STAGING= FIGO , transvaginal USS, endometrial biopsy
RISK FACTORS/ RED FLAGS :
- post menopausal bleeding, weightloss, anaemia ,
- exposure to unopposed oestrogen ( early period and late menopause)
- PCOS
- Oestrogen only HRT
- Nulliparity and obesity
HCG levels in viable intrauterine pregnancy ?
USED IN PREG OF U/K LOCATION
increase of more the 60% in 48hrs
HCG over 1500 should be able to be seen on USS
early menopause hormone levels ?
and investigation of choice
age is less than 40
- high FSH / LH
-Low Oestrogen
SERUM FSH TEST !
vaginal dryness , itching , burning and pain during sex in post menopausal woman ?
Atrophic Vaginitis
- vaginal mucosa appears thin and dry due to lack of oestrogen
Short height , webbed neck , recurrent otitis media , primary amenorrhoea
Turner syndrome ( single X chromosome )
- ovaries don’t respond to FSH/LH
lichen sclerosis ?
symptoms ?
treatment ?
chronic inflammatory skin condition
autoimmune linked to T1DM and Hypothyroidism
- white , shiny raised patches of skin on vagina, symtoms are worse with friction so loose clothing helps
TREATMENT= potent steroids ie :, Clobetasol Propionate
cervical cancer risks
- lots of children
-COCP
-Smoking
-Low status background
-HPV
-Many sexual partners
causes of secondary amenorrhoea (loss of period for more than 6 months when she previously has a normal period )
-Pregnancy (most common cause)
- Breastfeeding
- Menopause
- Intrauterine adhesions leading to outflow tract obstruction (Asherman’s syndrome)
- PCOS
- Physical stress, excess exercise, and weight loss
-Pituitary gland pathology, such as Sheehan syndrome or hyperprolactinaemia
- Hypothyroidism or hyperthyroidism
menorrhagia treatment
Tranexamic acid ( for blood loss)
or mirena coil
Ovarian cancer risk and symptoms
> Advanced age
Smoking
Increased number of ovulations (early menarche, late menopause)
Obesity
Hormone replacement therapy (HRT)
Genetic predisposition (BRCA 1 and 2 genes)
Symptoms :
bloating and early satiety , abdominal discomfort and change in urinary or bowel habit
painful and heavy period
mefenamic acid (NSAID)
red flag for post menopausal bleeding
endometrial cancer
markers for
a) ovarian cancer
b) pancreatic cancer
c) Hepatocelullar carcinoma
d) colorectal cancer
a) CA125
b) CA19-9
c) AFP
d) CEA
Ectopic pregnancy treatment
a) methotrexate < 35mm
b) >35mm or if heart beat is present => salpingectomy , salpingostomy
management of uterine fibroid <3cm
medication to shrink uterine fibroid ?
IUS, tranexamic acid, COCP
To shrink :
- GnRH agonist ( short term ) due to menopausal side effects = Triptorelin
Woman aged > 30 years with dysmenorrhoea, menorrhagia, enlarged, boggy uterus → ?
adenomyosis
ectopic pregnancy signs
+ female with a history of 6-8 weeks amenorrhoea + lower abdominal pain and later develops vaginal bleeding
+HcG >1500
after pregnancy , urine leaking = stress incontinence when they sneeze or laugh
pelvic floor excersizes
DULOXETINE
dustressetine
causes of primary amenorrhoea
gonadal dysgenesis (e.g. Turner’s syndrome) - the most common cause
- testicular feminisation
- congenital malformations of the genital tract
- functional hypothalamic
- amenorrhoea (e.g. secondary to anorexia)
- congenital adrenal hyperplasia
- imperforate hymen
