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MED SCHOOL Y4 > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

PCOS medications
a) for regular cycle , acne and hirtuism
b) to induce ovulation

A

a) Metformin , COCP , CO-pyrindrol
b) Clomifene = induces ovulation and improves conception rates

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2
Q

Endometriosis symptoms
diagnosis ?

A
  • endometrial tissue outside the uterus
    + chronic pelvic pain
    + heavy menstrual periods
    + infertility
    +irregular bleeding
    + dyspareunia = pain during sex

diagnosis = laparoscopy

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3
Q

heavy bleeding + pain ( everything is normal )
treatment

A

Mefenamic acid

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4
Q

PCOS criteria

A

Rotterdam Criteria :
- Oligo or an ovulation
- hyperandrogensim
- clinical or biochemical polycystic ovaries on USS

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5
Q

Treatment for PID

A
  • Cover chlamydia - doxycycline
  • Cover Gonorrhoea- IM ceftriaxone
  • Cover BV - metronidazole

or Ofloxacin + metronidazole

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6
Q

staging for endometrial cancer and risk factors

A

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

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7
Q

HCG levels in viable intrauterine pregnancy ?
USED IN PREG OF U/K LOCATION

A

increase of more the 60% in 48hrs
HCG over 1500 should be able to be seen on USS

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8
Q

early menopause hormone levels ?
and investigation of choice

A

age is less than 40
- high FSH / LH
-Low Oestrogen

SERUM FSH TEST !

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9
Q

vaginal dryness , itching , burning and pain during sex in post menopausal woman ?

A

Atrophic Vaginitis
- vaginal mucosa appears thin and dry due to lack of oestrogen

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10
Q

Short height , webbed neck , recurrent otitis media , primary amenorrhoea

A

Turner syndrome ( single X chromosome )
- ovaries don’t respond to FSH/LH

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11
Q

lichen sclerosis ?
symptoms ?

treatment ?

A

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

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12
Q

cervical cancer risks

A
  • lots of children
    -COCP
    -Smoking
    -Low status background
    -HPV
    -Many sexual partners
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13
Q

causes of secondary amenorrhoea (loss of period for more than 6 months when she previously has a normal period )

A

-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

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14
Q

menorrhagia treatment

A

Tranexamic acid ( for blood loss)
or mirena coil

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15
Q

Ovarian cancer risk and symptoms

A

> 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

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16
Q

painful and heavy period

A

mefenamic acid (NSAID)

17
Q

red flag for post menopausal bleeding

A

endometrial cancer

18
Q

markers for
a) ovarian cancer
b) pancreatic cancer
c) Hepatocelullar carcinoma
d) colorectal cancer

A

a) CA125
b) CA19-9
c) AFP
d) CEA

19
Q

Ectopic pregnancy treatment

A

a) methotrexate < 35mm
b) >35mm or if heart beat is present => salpingectomy , salpingostomy

20
Q

management of uterine fibroid <3cm
medication to shrink uterine fibroid ?

A

IUS, tranexamic acid, COCP
To shrink :
- GnRH agonist ( short term ) due to menopausal side effects = Triptorelin

21
Q

Woman aged > 30 years with dysmenorrhoea, menorrhagia, enlarged, boggy uterus → ?

A

adenomyosis

22
Q

ectopic pregnancy signs

A

+ female with a history of 6-8 weeks amenorrhoea + lower abdominal pain and later develops vaginal bleeding
+HcG >1500

23
Q

after pregnancy , urine leaking = stress incontinence when they sneeze or laugh

A

pelvic floor excersizes
DULOXETINE
dustressetine

24
Q

causes of primary amenorrhoea

A

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

25
Q

How to interpret FSH AND LH in amenorrhoea

A

-low levels of FSH, LH –>hypothalamic cause
-High levels of FSH, LH–> Ovarian problem. (primary ovarian failure )
or gonadal dysgenesis –> Turners syndrome

26
Q

Hydatidiform mole on USS

A

‘snow storm’ appearance on ultrasound scan

Features:
+ vaginal bleeding
+ uterus size greater than expected for gestational age
+ abnormally high serum hCG
+ ultrasound: ‘snow storm’ appearance of mixed echogenicity

27
Q

Hyperemesis gravidarum treatment and features

A

fluids with K+
they are at risk of hypokalaemia !

diagnostic features :
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

28
Q

what is the risk of HRT
- progesterone
-oestrogen

A

progesterone - Increased risk of breast cancer and VTE
Oestrogen - increased risk of Endometrial cancer

-

29
Q

treatment for candidiasis
symptoms

A

white thick curd like discharge
pH<4.5
- oral fluconazole 150mg single dose first line
-if contraindicated then clotrimazole 500mg intravaginal pessary ( pregnant women)

30
Q

miscarriage treatment

A

1) wait and see for 7-14 days
2) Vaginal misoprostol ( give with anti emetics and pain relief ) and contact doctor if bleeding doesn’t begin in 24hrs
3) Surgical suction curettage or vacuum aspiration

31
Q

risk factors for ectopic pregnancy

A
  • endometriosis
  • previous ectopic
  • damage to the tubes ie : PID , surgery
    -IUCD
  • POP
    -IVF
32
Q

Urge incontinence ?
Stress incontinence ?

A

Urge -> bladder retraining , oxybutynin
Stress-> Pelvic floor muscle training , duloxetine

33
Q

medical abortion

A
  • Oral Mifepristone and vaginal misoprostol
34
Q

Trichomonas Vaginalis
symptoms
treatment

A

offensive yellow, green frothy discharge
vulvovaginitis
strawberry cervix
metronidazole

35
Q

Androgen insensitivity syndrome

A

they have undescended testes , and you can feel 2 bilateral pelvic masses , elevated testosterone because the testes are insensitive to it !

Primary amenorrhoea, little or no axillary and pubic hair, elevated testosterone → androgen insensitivity syndrome

These findings all point in the direction of AIS, which is an X-linked recessive condition characterised by end-organ resistance to testosterone, causing genetically male children (46XY) to have a female phenotype.

36
Q

premature ovarian failure signs and management

A

RAISED FSH/LH but low oestrogen because the ovaries fail and don’t respond to the FSH

Premature ovarian insufficiency: hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of 51 years

MED SCHOOL Y4 (19 decks)

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