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Medicine > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Endometrial cancer type I versus type II

A

Type 1 - oestrogen related, adenocarcinoma
Type 2 - serous, clear cell, non endomatrioid, undifferentiated carcinoma or carcinosarcoma

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2
Q

Type I endometrial ca presentation

A

PMB, AUB in pre-menopause, intermenstrual bleeding

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3
Q

Type II endometrial ca presentation and RFs

A

AUB
Associated with parous women, black, p53 mutation, HER 2

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4
Q

RFs endometrial ca

A

Cancer (ovarian, breast, colon - HNPCC/Lynch II)
Obesity
Late menopause
DM
Nulliparity
Unopposed oestrogen (PCOS, HRT, anovulation)
Tamoxifen (chronic)

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5
Q

Investigation endometrial ca

A

TVUSS + biopsy
Bloods including tumour markers

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6
Q

Classification of endometrial ca?

A

FIGO I-IV

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7
Q

Treatment endometrial ca

A

Surgery +/- chemo/radio
Hormone therapy if fertility sparing - PO progesterone or progesterone IUD

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8
Q

Uterine Sarcomas (4)

A
  1. Leiomyosarcoma
  2. Endometrial stromal sarcoma
  3. Undifferentiated
  4. Adenosarcoma
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9
Q

Leiomyosarcoma

A

Rapidly enlarging fibroids in peri-postmenopausal women

AUB

Tx: Hysterectomy

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10
Q

Ovarian cancer symptoms

A

Abdominal pain, bloating, dyspepsia, early satiety, urinary and bowel symptoms

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11
Q

Types of ovarian cancer

A

GEMS: germ cell, epithelial, metastases (GI), sex cord-stromal

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12
Q

Risk Factors/ Protective factors for Ovarian ca

A

RFs:
early menarche
late menopause
nulliparity
BRCA genes
Smoking

Protective:
COCP
breastfeeding
pregnancy

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13
Q

Tumour markers for ovarian ca

A

CA-125

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14
Q

Investigations for ovarian ca

A

Pelvic USS
CT + biopsy

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15
Q

Treatment ovarian cancer

A

Surgery +/- chemo and radio

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16
Q

Classification of ovarian ca

A

FIGO

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17
Q

Cervical cancer

A

90% SCC, 10% adenocarcinoma

RFs: HPV (16/18), high risk sex behaviours

Dx: cervical screening then colposcopy

Tx: surgery +/- chemo/radio depending on staging

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18
Q

Fallopian tube ca triad

A
  1. watery discharge
  2. vaginal bleeding/ discharge
  3. crampy lower abdo/ pelvic pain
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19
Q

Lichen sclerosus

A

White plaques on vulva
Tx: high dose steroids (clobetasol)
can develop into SCC

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20
Q

Lichen simplex

A

Pruritic rash with hyperkeratotic skin

Tx: moderate potency steroid and night-time antihistamine

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21
Q

Lichen planus

A

Autoimmune T-cell attack on keratinocytes

Erythematous rash

Tx: Ultrapotent steroid cream or immunosuppressive therapy

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22
Q

Stages of the Menstrual Cycle (

A

Follicular phase
1. Follicles mature, secondary follicle develops FSH/ LH receptors.
2. Produce oestrogen –> cervical mucus permeability increases, neg feedback LH/FSH
3. Dominant follicle emerges
4. LH spike just before ovulation causing follicle to release unfertilised egg (ovum)

Luteal phase
1. Follicle collapses into corpus luteum which secretes progesterone
- Progesterone maintains the endometrial lining, thickens the cervical mucus
2. Corpus luteum also secretes oestrogen
3. IF FERTILISED: embryo secretes HCG which maintains the corpus luteum
4. NO FERTILISATION: breakdown of corpus luteum, stops producing oestrogen and progesterone causing endometrium breakdown

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23
Q

Premenstrual syndrome

A

At least one affective and one somatic symptom during the 5d before mensus

Tx:
Exercise, vitamin B6, CBT
Low dose SSRIs
Second line: estradiol patches

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23
Q

Premenstrual dysphoric disorder

A

Severe PMS with impairment in daily functioning

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23
Q

Treatment AUB

A

Mild:
NSAIDs, COCP, progestrins, Mirena

Surgical: polypectomy, myomectomy, endometrial ablation

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23
Q

Management heavy menstrual bleeding

A

No contraception -
tranexamic acid or mefenamic acid if pain

Contraception -
Mirena coil first line
COCP
Cyclical oral progesterone

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24
Q

Endometriosis

A

Endometrial tissues outside the uterus

25
Q

Symptoms of endometriosis (5)

A
  1. Dysmenorrhea
  2. Dyspareunia
  3. Dysuria
  4. Dyschezia
  5. Infertility
26
Q

Investigation/ treatment of endometriosis

A

Laparoscopy (gold standard)

Tx: NSAIDs, OCP, Mirena
GnRH agonist/ Danazol
surgery

27
Q

Adenomyosis

A

Extension of endometrial tissue into myometrium

28
Q

Adenomyosis features, investigation and treatment

A

HMB, dysmenorrhea/ dyspareunia, pelvic pain

Ix: clinical –> bulky uterus
USS/ MRI

Tx: medical (as endometriosis) or surgery

29
Q

Fibroids

A

Present with HMB, prolonged menstruation, abdominal pain and bloating

Ix: hysteroscopy, pelvic USS

Mx:
<6-8cm watch and wait, manage bleeding with Mirena

GnRH agonist - Lupron
- stops bleeding and shrinks fibroids
- surgical management

30
Q

Fibroid management UK

A

<3cm: treat HMB and symptoms

> 3cm and symptomatic: NSAIDs and tranexamic acid, Mirena, COCP AND REFER TO GYNAE

Surgery for larger fibroids –> uterine artery embolization

31
Q

COCP Absolute contraindications (10)

A

<4 weeks post partum
Major surgery
?pregnancy
Undiagnosed vaginal bleeding
DVT/PE
Coagulopathies
Impaired liver function
Smoker
Migraines with focal neurology
Uncontrolled HTN

32
Q

COCP Relative Contraindications

A

Migraine no focal neuro
DM with vascular disease
SLE
Controlled HTN
Hyperlipidaemia
Sickle cell
GB disease

33
Q

How which days can you start COCP without back up contraception

A

Day 1-5 of menstrual cycle

After that you need 7 days of barrier due to risk of already developing follicle/ ovulation

34
Q

How does COCP work?

A

Oestrogen and progesterone negative feedback inhibit LH/FSH therefore no ovulation

34
Q

Missed pills

A

1 pill <24h - take asap

> 1pill in 1st week:
take asap
Use back up for 7 days
Emergency contraception if had unprotected sex

<3 pills in 2nd or 3rd week:
Take asap
No pill-free week
Barrier not needed

> 3 pills in 2nd or 3rd week:
Take asap
No pill free week
Use back up for 7 days
May need emergency contraception

34
Q

IUS

A

Mirena - progesterone device

35
Q

Depo-Provera

A

Every 3 months

36
Q

Implant (Nexplanon)

A

Lasts 3 years

37
Q

Copper IUD

A

Last up to 5 years, can be used as emergency contraception

38
Q

Emergency contraception

A
  1. Levongesterel - within 72h
  2. Yuzpe - COCP, within 72h
  3. Ulipristal - in 5 days
  4. Copper IUD up to 7 days
39
Q

TOP

A

<9wks:
mifepristone and misoprostol
<14wks:
surgical
14-24wk:
misoprostol + oxytocin
>24wks: induction of labour

40
Q

Threatened miscarriage

A

Bleeding and cramping
Live foetus
Closed cervix

Watch and wait

41
Q

Inevitable miscarriage

A

Bleeding
Live foetus low in uterus
Cervix open

Watch and wait
Misoprostol
D+C

42
Q

Incomplete

A

Residual tissue, Cervix open

Watch and wait
Misoprostol
D+C

43
Q

Complete

A

Empty sac, cervix closed, no bleeding

No management needed

44
Q

Missed

A

No bleeding (foetal death in utero), still in utero, cervix closed and no bleeding

Mifepristone and then misoprostol

45
Q

Commonest sites ectopic pregnancy

A
  1. Ampulla
  2. Isthmal
  3. Fimbral
46
Q

Which women need Rhogam during miscarriage?

A

If resus negative

47
Q

PCOS Rotterdam classification

A
  1. Anovulation/ irregular menses
  2. Excess androgens
  3. Cysts on USS
48
Q

PCOS management

A

Infertility - weight loss, clomiphene, metformin

Managing risk endometrial ca: COCP

Hirsutism:
OCP (Diane, Yasmin), finasteride, spironolactone

49
Q

HPV strains that cause warts

A

6 and 11

50
Q

PID

A

Features: cervical/ adnexal tenderness, fever, lower abdo pain, abnormal discharge, dyspareunia

Ix: bloods, bimanual exam

Tx: antibx
outpatient: ceftriaxone IM + PO doxycycline

inpatient: IV cefoxitin and PO/IV doxycycline

51
Q

TSS management

A

Vancomycin + clindamycin + Pip-taz

52
Q

Menopause

A

Cessation of ovulation/ periods

High LH/FSH, Low oestrogen and progesterone

53
Q

Management of perimenopause

A

Vasomotor - HRT, tibolone (can only be used 12 months after), clonidine

Vaginal oestrogen/ tablet for dryness and atrophy

54
Q

Side effects of Depo-Provera

A
  1. Weight gain
  2. Osteoporosis
55
Q

Contraindications to HRT

A
  1. Acute liver disease
  2. Hx of breast ca
  3. DVT/PE
  4. Cardiovascuar disease
  5. Undiagnosed vaginal bleeding
56
Q

Anterior vaginal wall prolapse (cystocele)

A

Bladder protrudes into anterior vaginal wall

LUTS, UTIs

Treat conservatively: pelvic floor exercises, pessary

57
Q

Posterior vaginal wall prolapse (rectocele)

A

Protrusion of rectum into posterior vaginal wall

Straining/ constipations

Treat conservatively, laxatives, posterior repair

58
Q

Uterine prolapse

A

Protrusion of uterus or cervix into vagina

Conservative management , surgery

59
Q

Vault prolapse (enterocele)

A

Protrusion of small intestine into lower pelvic cavity, pushing on vagina

Conservative or surgical treatment

60
Q

Stress incontinence

A

Urinary leaking when laughing or coughing.

Tx: pelvic floor exercises, vaginal laser or urethral bulking

61
Q

Overactive Bladder

A

Urge incontinence

Tx:
1. Lifestyle
2. Bladder training
3. Anticholinergics

Medicine (16 decks)

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