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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
Treatment AUB
Mild: NSAIDs, COCP, progestrins, Mirena Surgical: polypectomy, myomectomy, endometrial ablation
23
Management heavy menstrual bleeding
No contraception - tranexamic acid or mefenamic acid if pain Contraception - Mirena coil first line COCP Cyclical oral progesterone
24
Endometriosis
Endometrial tissues outside the uterus
25
Symptoms of endometriosis (5)
1. Dysmenorrhea 2. Dyspareunia 3. Dysuria 4. Dyschezia 5. Infertility
26
Investigation/ treatment of endometriosis
Laparoscopy (gold standard) Tx: NSAIDs, OCP, Mirena GnRH agonist/ Danazol surgery
27
Adenomyosis
Extension of endometrial tissue into myometrium
28
Adenomyosis features, investigation and treatment
HMB, dysmenorrhea/ dyspareunia, pelvic pain Ix: clinical --> bulky uterus USS/ MRI Tx: medical (as endometriosis) or surgery
29
Fibroids
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
Fibroid management UK
<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
COCP Absolute contraindications (10)
<4 weeks post partum Major surgery ?pregnancy Undiagnosed vaginal bleeding DVT/PE Coagulopathies Impaired liver function Smoker Migraines with focal neurology Uncontrolled HTN
32
COCP Relative Contraindications
Migraine no focal neuro DM with vascular disease SLE Controlled HTN Hyperlipidaemia Sickle cell GB disease
33
How which days can you start COCP without back up contraception
Day 1-5 of menstrual cycle After that you need 7 days of barrier due to risk of already developing follicle/ ovulation
34
How does COCP work?
Oestrogen and progesterone negative feedback inhibit LH/FSH therefore no ovulation
34
Missed pills
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
IUS
Mirena - progesterone device
35
Depo-Provera
Every 3 months
36
Implant (Nexplanon)
Lasts 3 years
37
Copper IUD
Last up to 5 years, can be used as emergency contraception
38
Emergency contraception
1. Levongesterel - within 72h 2. Yuzpe - COCP, within 72h 3. Ulipristal - in 5 days 4. Copper IUD up to 7 days
39
TOP
<9wks: mifepristone and misoprostol <14wks: surgical 14-24wk: misoprostol + oxytocin >24wks: induction of labour
40
Threatened miscarriage
Bleeding and cramping Live foetus Closed cervix Watch and wait
41
Inevitable miscarriage
Bleeding Live foetus low in uterus Cervix open Watch and wait Misoprostol D+C
42
Incomplete
Residual tissue, Cervix open Watch and wait Misoprostol D+C
43
Complete
Empty sac, cervix closed, no bleeding No management needed
44
Missed
No bleeding (foetal death in utero), still in utero, cervix closed and no bleeding Mifepristone and then misoprostol
45
Commonest sites ectopic pregnancy
1. Ampulla 2. Isthmal 3. Fimbral
46
Which women need Rhogam during miscarriage?
If resus negative
47
PCOS Rotterdam classification
1. Anovulation/ irregular menses 2. Excess androgens 3. Cysts on USS
48
PCOS management
Infertility - weight loss, clomiphene, metformin Managing risk endometrial ca: COCP Hirsutism: OCP (Diane, Yasmin), finasteride, spironolactone
49
HPV strains that cause warts
6 and 11
50
PID
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
TSS management
Vancomycin + clindamycin + Pip-taz
52
Menopause
Cessation of ovulation/ periods High LH/FSH, Low oestrogen and progesterone
53
Management of perimenopause
Vasomotor - HRT, tibolone (can only be used 12 months after), clonidine Vaginal oestrogen/ tablet for dryness and atrophy
54
Side effects of Depo-Provera
1. Weight gain 2. Osteoporosis
55
Contraindications to HRT
1. Acute liver disease 2. Hx of breast ca 3. DVT/PE 4. Cardiovascuar disease 5. Undiagnosed vaginal bleeding
56
Anterior vaginal wall prolapse (cystocele)
Bladder protrudes into anterior vaginal wall LUTS, UTIs Treat conservatively: pelvic floor exercises, pessary
57
Posterior vaginal wall prolapse (rectocele)
Protrusion of rectum into posterior vaginal wall Straining/ constipations Treat conservatively, laxatives, posterior repair
58
Uterine prolapse
Protrusion of uterus or cervix into vagina Conservative management , surgery
59
Vault prolapse (enterocele)
Protrusion of small intestine into lower pelvic cavity, pushing on vagina Conservative or surgical treatment
60
Stress incontinence
Urinary leaking when laughing or coughing. Tx: pelvic floor exercises, vaginal laser or urethral bulking
61
Overactive Bladder
Urge incontinence Tx: 1. Lifestyle 2. Bladder training 3. Anticholinergics

Medicine (16 decks)

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