Gynaecology Flashcards
What is a cystocele?
= bladder prolapse
Primary vs secondary amenorrhoea?
Primary: no periods however, has never had a period before
Secondary: not having periods (but has had periods before)
What kind of cells line the cervix?
= columnar epithelial cells
What type of epithelial cells line the vagina?
= squamous epithelial cells
What is ectropion cervix?
= this occurs when columnar epithelial cells that are usually restricted to the cervix extend into the vagina
Hypothalamic-pituitary-gonadal axis: What does the hypothalamus release?
= gonadotrophin releasing hormone (GnRH)
Hypothalamic-pituitary-gonadal axis: GnRH stimulates the anterior pituitary to produce what 2 hormones?
- luteinising hormone (LH)
- follicle-stimulating hormone (FSH)
What to the theca granulosa cells around the follicles secrete?
= oestrogen
What effect does oestrogen have on the hypothalamus + anterior pituitary?
= negative feedback effect, suppress’ the release of GnRH, LH + FSH
Where is progesterone produced after ovulation?
= corpus luteum
From 10 weeks gestation onwards where is progesterone produced from?
= placenta
When does puberty start for girls + boys?
Girls: 8-14
Boys: 9-15
Do overweight children go through puberty earlier or later? and why?
= earlier
Aromatase is an enzyme found in adipose (fat) tissue, that is important in the creation of oestrogen. Therefore, the more adipose tissue present, the higher the quantity of the enzyme response for oestrogen creation
What is the Tanner Staging system?
= objective classification system that providers use to document and track the development and sequence of secondary sex characteristics of children during puberty
What 2 phases make up the menstrual cycle?
= follicular + luteal
What are follicles made up of?
= oocyte, surrounded by granulosa cells
4 key stages of development in the ovaries
- primordial follicles
- primary follicles
- secondary follicles
antra follicles (AKA, Graafian follicles)
At which stage does a follicle develop FSH receptors + require stimulation to continue developing?
= secondary follicle
What are the bartholin’s glands?
= situated within the vestibule, just lateral to the introitus
Their primary function is to secrete a lubricating fluid
Management of bartholin cysts?
= incision + drainage (under local)
Majority of cervical cancers?
= squamous cell carcinoma (70-80%)
Which HPV virus’ increase your risk factor of developing cervical cancer? (2)
- HPV 16
- HPV 18
First-line investigation for cervical cancer?
= urgent colposcopy
(allows visualisation + biopsy of cervix)
Cervical cancer screening is for all women + people with a cervix between which ages?
= 25-64 years
How often are women called for cervical screening? (2)
Between 25-49 - every 3 years
49-64 - every 5 years
Gardasil is a vaccination used + protects against what?
= HPV (types 6,11,16,18,31,33,45,52 and 58)
Primary vs. secondary dysmenorrhoea
Primary = idiopathic, and occurs in the absence of pelvic pathology
Secondary = associated with underlying pathology such as endometriosis, pelvic inflammatory disease, or uterine fibroids
What imaging can be used to investigate ectopic pregnancy?
= pelvic USS
What is an ectopic pregnancy?
= medical condition in which the fertilised egg, or embryo, implants and begins to grow outside of the uterine cavity, usually in the fallopian tubes
Investigations for an ectopic pregnancy (2)
- pregnancy test
- transvaginal USS (to locate pregnancy)
Medical management for an ectopic pregnancy
= Methotrexate
What is a salpingectomy?
= removal of one or both Fallopian tubes
Main risk factor for endometrial cancer?
= exposure to unopposed oestrogen
Scan used to help investigate endometrial cancer?
= transvaginal USS
What is a hysterectomy with bilateral salpingo-oophorectomy?
= the removal of one (unilateral) or both (bilateral) of your ovaries and fallopian tubes
What is endometriosis?
= a gynaecological condition where endometrium-like tissue, which typically lines the uterus, proliferates outside the uterine cavity
Gold-standard diagnostic tool for endometriosis?
(however, NOT first-line)
= diagnostic laparoscopy
(carries a small risk of complications (e.g., bowel perforation))
Imaging which can be used to diagnose endometriosis
= transvaginal USS
What are fibroids?
= benign smooth muscle tumours originating from the myometrium of the uterus
What are uterine leiomyomas also known as?
= fibroids
Investigation for a genital prolapse?
= pelvic examination
What is a good option for a women who may not be suitable for surgery to provide symptomatic relief for their genital prolapse?
= pessary use
What are vasomotor symptoms? (2)
Cardinal symptoms of menopause
- hot flashes
- night sweats
Which route of HRT delivery is preferred if the women is at risk of VTE?
- oral
- vaginal (via pessary)
- transdermal
- transdermal
What are the chances (%), of a couple conceiving within 1 year if the women is younger than 40 years, they don’t use contraception, and have regular intercourse?
= 80%
Investigations for infertility (3)
- hormonal studies
- semen analysis
- USS, hysterosalpingography or laparoscopy to evaluate uterus, Fallopian tubes + ovaries
What is lichen sclerosus?
= inflammatory dermatological condition which predominantly affects the genital and anal regions of the body but can present elsewhere
Are males or females more likely to suffer from lichen sclerosus?
= females
Management of lichen sclerosus (3)
- topical corticosteroids
- avoidance of soaps
- emollients, to relieve dryness + soothe itching
What is menopause?
= describes the permanent cessation of menstruation, characterised by at least 12 months of amenorrhoea in otherwise healthy women > 45, who are not using hormonal contraception
What is perimenopause?
= this period begins when symptoms of menopause start and continues until 12 months after the last menstrual period
What 2 types of HRT are available, and who are they for?
- continuous, for postmenopausal women not having periods
- cyclical, for perimenopausal women still having periods
Benefits of HRT (2)
- relieve vasomotor + urogenital symptoms
- reduce risk of osteoporosis
Risk involved in HRT (3)
Increased risk of
- breast cancer
- endometrial cancers
- VTEs
What is menorrhagia?
= excessive blood loss during a menstrual period to an extent that substantially affects a woman’s quality of life
Investigations for menorrhagia (including imaging) (3)
- FBC + iron studies
- clotting screen
- transvaginal USS
Treatment options for menorrhagia (4)
- Mirena coil
- Mefenamic acid (NSAID)
- Tranexamic acid
- hormonal contraception (e.g., combined oral contraceptive pill)
In rare cases refractory to medical management: endometrial ablation, or hysterectomy may be considered
What is a miscarriage?
= defined as the loss of pregnancy prior to 24 weeks gestation
Clinical feaures of a miscarriage (3)
- pain
- vaginal bleeding
- vaginal tissue loss
In a threatened miscarriage is the cervical os open or closed?
= closed
In an inevitable miscarriage is the cervical os open or closed?
= open
In a complete miscarriage is the cervical os open or closed?
= usually closed
In a missed miscarriage is the cervical os open or closed?
= closed
Imaging used in suspected miscarriage?
= transvaginal USS
Medical management for a miscarriage?
= Misoprostol
Surigical management of a miscarriage?
= dilation + currettage
What is ‘expectant management’ in regards to a miscarriage?
= allow products of conception to naturally expel
What is a recurrent miscarriage?
= defined as loss of 3 or more consecutive pregnancies
Which of the following types of ovarian cancer is usually cystic in nature?
- epithelial ovarian tumour
- germ cell tumours
- sex cord stromal tumours
- epithelial ovarian tumour
Which of the following types of ovarian cancer accounts for approximately 90%?
- epithelial ovarian tumour
- germ cell tumours
- sex cord stromal tumours
- epithelial ovarian tumour
Which of the following types of ovarian cancer most commonly arise in young women?
- epithelial ovarian tumour
- germ cell tumours
- sex cord stromal tumours
- germ cell tumours
Which of the following types of ovarian cancer predominantely spread via the lymphatic route?
- epithelial ovarian tumour
- germ cell tumours
- sex cord stromal tumours
- germ cell tumours
Which of the following types of ovarian cancer can be identified (tumour marker) by alpha-fetoprotein and sometimes beta human chorionic gonadotrophin (beta-hCG)?
- epithelial ovarian tumour
- germ cell tumours
- sex cord stromal tumours
- germ cell tumours
What is a Krukenberg tumour?
= refers to a ‘signet ring’ sub-type of tumour, typically GI origin, which has metastasised to the ovary
Signs and symptoms of ovarian cancer? (4)
- Abdominal discomfort
- Bloating
- Early satiety (=feeling full after small amount of food)
- Urinary frequency or change in bowel habits
Investigations for ovarian cancer (2)
- bloods, CA-125
- pelvic + abomdinal USS
What imaging is used to help stage ovarian cancer?
= CT scan
What is an ovarian cyst?
= fluid-filled sac that develops within or on the surface of an ovary
Investigations for an ovarian cyst (2)
- pregnancy test, to eclude ectopic pregnancy
- diagnostic laparoscopy - particularly when patient is unstable
What is overactive bladder syndrome?
= chronic condition that results from hyperactivity of the detrusor muscle, a layer of the urinary bladder wall
Symptoms associated with overactive bladder syndrome (4)
- urinary urgency
- urge incontinence
- frequency
- nocturia
3 key investigations in suspected overactive bladder syndrome
- urinalysis + culture (rule out infection)
- frequency/ volume chart
- urodynamics (evaluate bladder muscle function)
Non-pharmacological management for overactive bladder syndrome (2)
- behaviour modification (including reducing oral intake, avoiding caffeine and alcohol)
- bladder retraining (aim to increase the interval between the voids)
What is pelvic inflammatory disease (PID)?
= condition that arises when an infection spread from the vagina to the cervix, and subsequently to the upper genital tract
How is pelvic inflammatory disease (PID) predominately spread?
= via sexual contact
RUQ pain alongside PID suggests?
= Fitz-Hugh-Curtis Syndrome
Management of pelvic inflammatory
= a combination of antibiotics
(ceftriaxone (IM) + doxycycline + metronidazole OR, ofloxacin + metronidazole)
+ analgesia
Complications of PID (3)
- chroinc pelvic pain (40%)
- infertility (15%)
- ectopic pregnancy (1%)
What is Fitz-Hugh Curtis Sydrome?
= occurs when adhesions form between the anterior liver capsule and the anterior abdominal wall of the diaphragm in the context of PID
Definitive diagnosis + treatment of Fitz-Hugh Curtis Sydrome
= laparoscopy + administration of antibiotics
What is polycystic ovary syndrome (PCOS) disorder characterisded by? (3)
- hyperandrogenism (manifesting as oligomennorhea, hirtuitism and acne)
- ovulation disorders
- polycystic orvarian morphology
Biochemical findings in PCOS (3)
LH:FSH ratio - increase (>2)
Total testosterone - may be normal or slightly elevated
Fasting + oral glucose tolerance tests (OGTT) - used to diagnose insulin resistance
Imaging used in suspected PCOS
transabdominal + transvaginal USS
Rotterdam diagnostic criteriaa: PCOS can be diagnosed if..
At least 2 of the following criteria are met:
- polycystic ovaries (>12 cysts seen on imaging, or volume >10 cubic cm)
- oligo-/anovulation
- clinical or biochemical features of hyperandrogenism
PCOS: pharmacological treatment for women not planning pregnancy (3)
- Co-cyprindrol
- combined oral contaceptive pill (COCP)
- Metformin
What may cause post-coital bleeding (5)
- cervical ectropion
- endocervical and cervical polyps
- cervical cancer
- sexually transmitted infections
- atrophic vaginitis
What is postmenopausal bleeding defined as (2)
In women who are NOT receiving HRT = any vaginal bleeding that occurs more than 12 months after LMP
If a women is receiving HRT = any vaginal bleeding that occurs more than 6 months after menstruation has stopped
What is pre-menstrual syndrome (PMS)?
= refers to a cluster of psychological, physical, and behavioural symptoms that occur in the luteal phase of the menstrual cycle and cause distress or disruption to the patient’s life
Non-pharcological management for pre-menstrual syndrome (PMS) (5)
- diet changes
- increase exercise
- vitamin supplementation (vit B)
- stress reduction
- CBT
What is premature ovarian insufficiency (POI)?
= medical condition characterised by the onset of menopause in a women aged < 40. The term ‘premature’ is used to highlight the early onset of menopause compared to the normal age range
Investigations for pre-mature ovarian insufficiency (POI)
- raised FSH levels (indicative of menopause)
Levels should be repeated at least once more to ensure result was not anomalous
Management for premature ovarian insufficiency (POI) (2)
Primary management: offer HRT until at least the age of normal menopause
Psychological support - due to potential mental health impacts of early menopause
What is primary amenorrhoea?
= failure of menstrual periods to start by 15 years of age in a female with normal growth and secondary sexual characteristics
This condition may also be diagnosed at age 13 in the presence of absent pubertal maturation as well as absent menses
Investigations for primary amenorrhoea
- hormonal tests (assess FSH, LH, estradiol)
- genetic tests
What is secondary amenorrhoea?
= absence of menstruation for 6 months or longer in a woman who has previously had regular menstrual cycles
Most commonly vulval cancer are?
= squamous cell carcinomas
Risk factors of vulval cancer (3)
- increasing age
- exposure to HPV
- condition that cause chronic inflammation to the vulva
Primary management of vulval cancer
= surgery
(in advanced cases, radiotherapy with or without chemotherapy)
Commonest gynaecological cancer?
= endometrial
What is endometrial hyperplasia?
= pre-cancerous condition involving thickening of the endometrium
How is endometrial hyperplasia treated?
= treated by specialist using Progesterone, with either:
- intrauterine system (e.g., Mirena coil)
- continuous oral progesterone (e.g., medroxyprogesterone or levonorgestrel)
Most common type of endometrial cancer?
= adenocarcinoma
NICE: 2 week-wait urgent cancer referral criteria for suspected endometrial cancer? (2)
- postmenopausal bleeding (>12 months after the last menstrual period)
Referral for transvaginal USS in women >55 with:
- unexplained vaginal discharge
- visible haematuria + raised platelets, anaemia, or elevated glucose levels
Investigations for suspected endometrial cancer (3)
- transvaginal USS (for endometrial thickness)
- pipelle biopsy (highly sensitive)
- hysteroscopy (for biopsy)
Non-malignant causes for a rasied CA125 (6)
- endometriosis
- fibroids
- adenomyosis
- pelvic infection
- liver disease
- pregnancy
Physical examination findings which justify a 2-week-wait referral for suspected ovarian cancer (3)
- ascites
- pelvic mass (unless clearly due to fibroids)
- abdominal mass
Hereditary nonpolyposis colorectal cancer (HNPCC) increases your risk of developing? (2)
- colorectal cancer
- endometrial cancer
What is a large loop excision of the transformation zone (LLETZ)?
= procedure where a heated loop of wire is used to remove the tissue of the cervix
What is Erb’s palsy?
= a paralysis of the arm caused by the injury to the upper group of the main nerves supplying it, specifically the upper trunk C5-C6 of the brachial plexus (can occur during birth)
Which STI is most the most likely causative agent?
23-year-old man presents with dysuria and penile discharge. Microbiology reveals Gram negative diplococci
- chlamydia
- gonorrhoea
- syphilis
- bacterial vaginosis
- candida albicans
- trichomoniasis
- gonorrhoea
Which STI is most the most likely causative agent?
30-year-old womena presents with vulval itch, dysuria and a creamy vaginal discharge
- chlamydia
- gonorrhoea
- syphilis
- bacterial vaginosis
- candida albicans
- trichomoniasis
- candida albicans
Which STI is most the most likely causative agent?
35-year-old man presents with a painless 1cm ulcer on his penis
- chlamydia
- gonorrhoea
- syphilis
- bacterial vaginosis
- candida albicans
- trichomoniasis
- syphilis
