Gynaecology Flashcards by Anna Ramsay

tender inguinal lymphadenopathy and green urethral discharge

most likely gonorrhoea

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management of gonorrhoea

ceftriaxone

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when should a coil not be recommended

in patients with Pelvic inflammatory disease

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when is COCP contraindicated

in over 40s and high BMI

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what complications come with hormone replacement therapy

increased risk of breast cancer after 1 year of use
increased risk of endometrial cancer - in absence of progesterone
increased risk of VTE

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indications for hormone replacement therapy

vasomotor symptoms- hot flushes, insomnia + headaches
loss of bone density
premature menopause

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non-offensive vaginal discharge and microscopy showing gram negative diplococci

neisseria gonorrhoea

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offensive yellow/green frothy discharge

Trichomoniasis

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what is the role of Leydig cells?

produce testosterone
- produce and secrete in response to LH from anterior pituitary

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what is the role of Sertoli cells?

secrete androgen binding protein, support developing sperm and form blood-testes barrier

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what is the most common causes of postmenopausal bleeding?

vaginal atrophy
(atrophic vaginitis)

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management of persistent urge incontinence

antimuscarinic - oxybutynin, tolterodine or darifenacin

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what tests should be done for suspected PCOS?

pelvic ultrasound, FSH, LH, TSH, prolactin, testosterone and sex hormone-binding globulin (SHBG)

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diagnostic criteria for PCOS

Rotterdam criteria
2/3 of following
infrequent/ no ovulation
clinical and/ or biochemical signs of hyperandrogenism
polycystic ovaries on US ( >12 follicles/ increased ovarian volume)

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what antibiotic should be given to patients with PPROM?

10 days erythromycin

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management of gestational diabetes

1st line (<7mmol/L) = diet of low glycaemic index foods and regular exercise
2nd line(>7mmol/L) = metformin and exercise
3rd line if still not under control = insulin (short acting)

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medical management of incomplete miscarriage

if expectant management not worked then single dose of misoprostol

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medical management of missed miscarriage

mifepristone then misoprostol 48hours later

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treatment of pre-menstrual syndrome (PMS)

COCP
if contraindicated the fluoxetine

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When should testing for asymptomatic patients be done?

4 weeks after exposure
if negative repeat at 12 weeks

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presentation of Hepatitis A

flu-like symptoms, RUQ pain, tender hepatomegaly, deranged LFTs
(ALT is raised= viral hepatitis - HIV does not cause this)

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Diagnosis and screening of HIV

combination test - HIV p24 antigen and HIV antibody

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Examples of epithelial ovarian tumours

serous, mucinous, endometroid, clear cell , brenner

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Classification of ovarian tumours

epithelial
germ cell
sex-cord
metastatic

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first line investigation for suspected endometriosis

Trans vaginal ultrasound

contraindication for the progesterone only implant

active breasts cancer

Period of time that emergency contraceptives can be used?

levonorgestrel pill = up to 72 hours Ulipristal = up to 120 hours ^ cautioned in patients with asthma - use IUD instead (copper coil)

management for urge incontinence

bladder retraining anti-muscarinic - e.g. oxybutynin (avoided in elderly due to cholinergic burden)

what is the first change that occurs during female puberty

breast development

what type of epithelium lines the endocervix

simple columnar epithelium

what type of epithelium lines the external part of cervix

stratified squamous epithelium

what is a patient at increased risk of when taking progestogens?

breast cancer

medical management of urge incontinence

oxybutynin

medical management of stress incontinence

duloxetine

first line pharmacological management of infertility in patients with PCOS

after weight loss Clomifene

most common type of ovarian cancer

epithelial ovarian cancer (serous)

risk factors for endometrial cancer

'unopposed oestrogen' - e for estrogen and endometrium -nullparity -early menarche -late menopause - polycystic ovarian syndrome - oestrogen-only hormone replacement therapy

indications for surgical management of ectopic pregnancy

significant pain adnexal mass >35mm b-hCG level > 5000 foetal heartbeat present

what is the most common type of vulval cancer

squamous cell carcinoma

Investigation indicative of premature ovarian insufficiency

raised FSH and LH levels - underactivity of the ovaries -> lack of negative feedback on pituitary -> increase in gonadotropins low oestradiol levels

fishy vaginal discharge - what is it and management

bacterial vaginosis metronidazole

how is AIDS defined

evidence of an AIDS- defining illness alongside a CD4 count of <200 cells/mm3

how does syphilis present

single painless genital ulcer

medical management of atrophic vaginitis

topical oestrogen cream

what should be suspected in any woman presenting with post-menopausal bleeding

endometrial cancer all women >55 years should be referred using suspected cancer pathway

first line investigation for suspected endometrial cancer

trans vaginal ultrasound - normal thickness <4mm

what is the normal anatomical position of the uterus

anterverted and anteflexed

where is hCG secreted from in early pregnancy and what affect does this have

hCG secreted by the syncytiotrophoblast hCG stimulates corpus luteum to secrete progesterone

which cells secrete testosterone

leydig cells

what size of fibroid is indicative of surgery

>3cm symptomatic

first line treatment for pneumocystis pneumonia

co-trimoxazole

how long is luteal phase

ALWAYS 14 days long

what happens during the follicular phase

(menstrual and proliferative phase) rapid GnRH pulsatility -> LH slower GnRH release -> FSH

what does oestrogen do

develops female sex characteristics thins cervical mucus during follicular phase -> negative feedback on GnRH

what antibody can pass through the placenta

IgG - G for gestation

what is the site of spermatogenesis

seminiferous tubules

where does FSH act on in males and what is the outcome

FSH- acts on sertoli cells plays role in spermatogenesis

where does LH act on in males and what is the outcome

acts of leydig cells plays role in testosterone production

hypergonadotrophic hypogonadism FSH and LH levels and causes

lower than normal ovarian failure- postmenopausal and premature ovarian kleinfelter syndrome

hypogonadotrophic hypogonadism FSH and LH levels and causes

lower than normal levels hypopituitarism prolactinoma anabolic steroid use kallman's syndrome

first line management for urge incontinence

bladder retraining

first line management for stress incontinence

pelvic floor muscle training

define an intramural fibroid

within myometrium layer

define a subserosal fibroid

just below the outer layer of uterus

define a submucosal fibroid

just below the lining of uterus (the endometrium)