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Phase 3a🩺 > Gynaecology🍑 > Flashcards

Gynaecology🍑 Flashcards

1
Q

What is a cystocele?

A

A defect in the anterior vaginal wall that allows the bladder to prolapse backwards into the vagina

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2
Q

What is a urethrocele?

A

A prolapse of the urethra through a defect in the anterior vaginal wall

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3
Q

What is a urethrocystocele?

A

A prolapse of the bladder and urethra through a defect in the anterior vaginal wall

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4
Q

What is a uterine prolapse?

A

Where the uterus prolapses into the vagina

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5
Q

What is a rectocele?

A

Where the rectum prolapses into the vagina through a defect in the posterior vaginal wall

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6
Q

What is a vault prolapse?

A

Only occurs in women that have had a hysterectomy - where the top of the vagina prolapses into the vagina below it

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7
Q

Why does prolapse occur?

A

Weakness and lengthening of the ligaments and muscles surrounding the uterus, rectum and bladder

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8
Q

What are the risk factors for genital prolapse? (3)

A

Multiple vaginal deliveries Instrumental, prolonged or traumatic deliveryAdvanced age - postmenopausal statusObesity Chronic respiratory disease resulting in coughing Chronic constipation - straining

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9
Q

What is the presentation of a prolapse? (3)

A

Feeling of something coming down on the vagina
A dragging sensation in the pelvis
Urinary symptoms
Bowel symptoms
Sexual dysfunction

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10
Q

What are the urinary symptoms that prolapse can cause? (3)

A

Urgency Frequency Weak stream Retention

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11
Q

What are the bowel symptoms that prolapse can cause?

A

Constipation Incontinence Urgency

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12
Q

What sexual dysfunction symptoms can prolapse cause?

A

Pain Altered sensation Reduced enjoyment

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13
Q

What is the grading of a uterine prolapse?

A

Grade 0 - Normal Grade 1 - prolapse is more than 1cm above the introitus Grade 2 - prolapse is within 1cm of the introitus Grade 3 - prolapse is more than 1cm below the introitus, but not fully descended Grade 4 - full descent with eversion of the vagina

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14
Q

What are the three management options for prolapse?

A

Conservative management Vaginal pessary Surgery

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15
Q

What is involved in conservative management of urinary incontinence?

A

Pelvic floor exercisesWeight loss Reduction of caffeine intake Incontinence pads Anticholinergic medications for stress incontinence Vaginal oestrogen cream

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16
Q

What is a vaginal pessary?

A

A structure inserted into the vagina to provide support to the pelvic organs

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17
Q

What types of vaginal pessary exist?

A

Rings
Shelf
Gellhorn
Cube
Donut
Hodge

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18
Q

What does oestrogen cream do for the vagina?

A

Prevents it from irritation

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19
Q

What is the definitive treatment of pelvic organ prolapse?

A

Surgery - surgical repair of the prolapse, or hysterectomy

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20
Q

What are the complications of pelvic organ prolapse surgery? (3)

A

Pain, bleeding and infection Damage to the bladder or bowel Recurrence of prolapse Altered experience of sex

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21
Q

What are the first line investigations for pelvic organ prolapse? (3)

A

Bimanual palpation for prolapsePost-void residual urine volume (to check for retention)Urinalysis

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22
Q

What are the two types of urinary incontinece?

A

Stress incontinence Urge incontinence

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23
Q

What is the cause of urge incontinence?

A

Overactivity of the detrusor muscle, which causes the sudden urge to urinate

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24
Q

What is the cause of stress incontinence?

A

Weakness of the pelvic floor and sphincter muscles, which allows urine to leak when pressure is high in the bladder

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25
Q

What is overflow incontinence?

A

Can occur when there is chronic urinary retention due to an obstruction to outflow. This results in an overflow of the urine, without the urge to pass urine.

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26
Q

What are the risk factors for urinary incontinence? (3)

A

Increased agePostmenopausal status Increased BMI Previous pregnancies and vaginal deliveriesPelvic organ prolapse Pelvic floor surgeryNeurological conditions Cognitive impairment

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27
Q

What modifiable lifestyle factors can contribute to symptoms of urinary incontinence? (3)

A

BMI Caffeine consumption Alcohol consumption Medications

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28
Q

What investigations can be used to diagnose urinary incontinence? (3)

A

Cough stress test Bladder diary Urinalysis Post-voidal residual measurement Urodynamic testing

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29
Q

What types of urodynamic testing can be performed?

A

Cystometry (looks at filling and emptying) Uroflowmetry (measures volume of urine released, the speed and how long it takes) Leak point pressure Post-void residual bladder volume Video urodynamic testing

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30
Q

What is cystometry?

A

Measures detrusor muscle contraction and pressure

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31
Q

What is the first line management of urinary incontinence? (3)

A

Conservative management - Bladder training - Pelvic floor exercises- Avoiding alcohol and caffeine - Weight loss- Avoiding excess fluid intake

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32
Q

What is the second line management of urinary incontinence?

A

Medication - Anticholinergics - oxybutynin (urgency)- Mirabegron (urgency)- Duloxetine (stress incontinence)

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33
Q

What are the side effects of anticholinergics? (3)

A

Dry mouth Dry eyes Urinary retention Constipation Postural hypotension

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34
Q

What other management options exist for urge incontinence? (3)

A

Botulinum toxin injection into the bladder wall Percutaneous sacral nerve stimualtion Augmentation cystoplasty - using bowel to increase the bladder size

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35
Q

How long should pelvic floor training be trialled for before further management?

A

3 months

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36
Q

What is pelvic inflammatory disease?

A

When an infection spreads into the upper genital tract through the vagina and cervix

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37
Q

What are the most common causes of PID?

A

Chlamydia trachomatisNeisseria gonorrhoea

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38
Q

What organism tends to cause more severe PID?

A

Neisseria gonorrhoea

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39
Q

How can PID be spread?

A

Predominantly sexually
Can also be contracted via UTI, respiratory infection and bacterial vaginosis

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40
Q

What are the non-sexually transmitted causes of PID?

A

E. coli Gardnerella vaginalis Haemophilus influenza

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41
Q

What are the risk factors for PID? (5)

A

Not using barrier protection Prior infection with chlamydia or gonorrhoea Multiple sexual partnersIUDYounger ageHistory of PID

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42
Q

What is the presentation of PID? (5)

A

Pelvic (adnexal tenderness) or abdominal pain Abnormal discharge Abnormal bleeding - intermenstrual or postcoital deep dyspareunia Dysuria Fever cervical excitation

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43
Q

What might be found on pelvic examination in PID?

A

Adnexal tendernessCervical motion tendernessUterine tenderness

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44
Q

What investigations are helpful in the diagnosis of PID?

A

Pelvic examinationNAAT swabs for gonorrhoea and chlamydia Pregnancy testInflammatory markers Transvaginal ultrasound

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45
Q

What is the treatment of PID?

A

IM ceftriaxone (gonorrhoea cover)Doxycycline (chlamydia cover)Metronidazole (for cover of aerobic bacteria)14 days of antibiotics

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46
Q

What are the complications of PID?

A

Infertility Chronic pelvic pain Ectopic pregnancyFitz-Hugh-Curtis syndrome

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47
Q

What is Fitz-Hugh-Curtis syndrome?

A

Adhesions between the anterior liver capsule and the peritoneum, in someone with a background of PID

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48
Q

What is the presentation of Fitz-Hugh-Curtis syndrome?

A

Right upper quadrant pain

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49
Q

How is Fitz-Hugh-Curtis syndrome diagnosed?

A

Laparoscopy

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50
Q

What is seen on laparoscopy in Fitz-Hugh-Curtis syndrome?

A

Violin string perihepatic lesions, no involvement of the liver parenchyma

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51
Q

What is the treatment of Fitz-Hugh-Curtis syndrome?

A

Same antibiotic regime as for PIDAdhesiolysis during laparoscopy

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52
Q

What are the differentials of PID? (3)

A

Ectopic pregnancy
Appendicitis
Ovarian cyst complications
Endometriosis

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53
Q

When should a coil be removed in someone with PID?

A

A coil should be left in, in a patient with PID, unless there is no response to antibiotics after 48-72 hours

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54
Q

What is the definition of menopause?

A

A permenant end to menstruation

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55
Q

What is the average age of menopause?

A

51 years

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56
Q

What does postmenopausal describe?

A

The period from 12 months after the final menstruation

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57
Q

When can menopause be diagnosed?

A

After a woman has had no periods for 12 months

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58
Q

What is the perimenopausal phase?

A

The time around menopause where women experience symptoms and irregular periods. It goes up to 12 months after the final period.

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59
Q

Before what age is menopause premature?

A

40 years

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60
Q

What are the symptoms of menopause? (6)

A

Vasomotor:- Hot flushes - Night sweats Sexual:- Vaginal dryness- Dyspareunia - Reduced libido Psychological:- Depression - Anxiety- Mood swings - Lethargy

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61
Q

What is the physiology of menopause?

A
  • Decline in growth of follicles - Reduction in production of oestrogen - Lack of negative feedback on pituitary results in more LH and FSH release- Ovulation stops due to decline in follicle growth - Endometrial growth ceases due to lack of oestrogen
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62
Q

What conditions does the menopause increase the risk of? (3)

A

Osteoporosis Cardiovascular disease and stroke Pelvic organ prolapse Urinary incontinence

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63
Q

What investigations are used to diagnose menopause?

A

In women over 45 - Diagnosis can be made clinically Women under 45 - FSH levels

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64
Q

What level of FSH is indicative of menopause?

A

FSH > 30

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65
Q

For how long after the menopause are women considered fertile?

A

2 years after their last menstruation in women under 50
1 year after their last menstruation in women above 50
All women are considered infertile after 55

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66
Q

What are the differentials of menopause? (3)

A

Pregnancy Polycystic ovary syndrome Hyperthyroidism HypothyroidismAdverse effects of medication

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67
Q

What is the non-hormonal management of menopause? (3)

A

Lifestyle changesSSRIs or SNRIs Clonidine CBT Vaginal moisturisers

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68
Q

What is the hormonal management of menopause?

A

HRT

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69
Q

What are fibroids?

A

Benign smooth muscle tumours of the myometrium of the uterus

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70
Q

What is the epidemiology of fibroids?

A

Fibroids affect 40-60% of women in later reproductive years Prevelance is slightly lower in women under 30

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71
Q

How do fibroids grow?

A

They grow in response to oestrogen It is thought that they originate from a single smooth muscle cell

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72
Q

What are the types of fibroids?

A

Submucosal - just below the lining of the uterus Intramural - within the myometrium Subserosal - just below the outer layer of the uterus Pedunculated - on a stalk

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73
Q

What are the differentials of fibroids?

A

AdenomyosisEndometriosisEndometrial polyps Endometrial hyperplasia Uterine sarcoma Pregnancy

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74
Q

What is the presentation of fibroids? (4)

A

Often asymptomatic Heavy menstrual bleeding Prolonged menstruation Abdominal pain BloatingUrinary or bowel symptoms Dyspareunia Reduced fertility

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75
Q

What are the risk factors for fibroids? (3)

A

Black ethnicity Increasing ageBeing overweight

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76
Q

What is the first line investigation for diagnosis of fibroids?

A

Transvaginal and transabominal ultrasoundHysteroscopy

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77
Q

What other investigations may be useful in diagnosis of fibroids? (2)

A

MRI Endometrial biopsy

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78
Q

What is the non-surgical management of fibroids? What is considered 1st line?

A

Mirena coil - often first line Anti-fibrinolytics NSAIDsCombined hormonal contraceptionGnRH agonist

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79
Q

What is the surgical management of fibroids? (3)

A

Endometrial ablation Resection of fibroids Uterine artery embolisationHysterectomy

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80
Q

What are the complications of fibroids? (5)

A

Reduced fertilityHeavy menstrual bleeding Pregnancy complications Torsion of fibroidMalignant change to leiomyosarcoma Ischaemia and necrosis of the fibroid (red degeneration)Constipation Urinary tract outflow obstruction

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81
Q

What happens during red degeneration?

A

A fibroid rapidly outgrows it’s blood supply during pregnancy and becomes ischaemic

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82
Q

Why does red degeneration occur?

A

Increased oestrogen during pregnancy promotes growth of the fibroids

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83
Q

What medication is used in a patient with fibroids before surgery?

A

GnRH agonists to reduce the size of the fibroids

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84
Q

What type of HRT should a woman that is still having periods be on?

A

Cyclical HRT with cyclical progesterone

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85
Q

What type of HRT should women without a uterus be on?

A

Oestrogen-only HRT

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86
Q

What type of HRT should women who have not had periods for more than 12 months be on?

A

Continuous combined HRT

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87
Q

Why is progesterone given to women with a uterus?

A

To protect the endometrium from endometrial hyperplasia and endometrial cancer, caused by the oestrogen

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88
Q

What is clonidine?

A

Clonidine is a alpha-2 adrenergic receptor agonist that can be useful for vasomotor symptoms and hot flushes

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89
Q

What are the indications for HRT? (3)

A

Replacing hormones in premature ovarian insufficiency
Reducing vasomotor symptoms
Improving symptoms of reduced libido, poor sleep and low mood
Reducing osteoporosis risk

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90
Q

What are the risks of HRT? (4)

A

Increased risk of breast cancerIncreased risk of endometrial cancerIncreased risk of venous thromboembolism Increased risk of stroke

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91
Q

What are the contraindications to HRT? (4)

A

Undiagnosed abnormal bleedingEndometrial hyperplasia Breast cancerUncontrolled hypertensionVenous thromboembolism Liver diseaseAngina or previous MIPregnancy

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92
Q

What is the most common type of ovarian cancer?

A

Epithelial cell tumour

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93
Q

What are the other types of ovarian tumours?

A

Germ cell tumours Sex-cord stromal tumours

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94
Q

What are germ cell ovarian tumours associated with?

A

Ovarian torsion

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95
Q

What tumour markers may be present in someone with a germ cell ovarian tumour?

A

Alpha fetoprotein Beta hCG

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96
Q

What age group are germ cell ovarian tumours most common in?

A

Young women

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97
Q

What are the risk factors for ovarian cancer? (3)

A

Age > 60 BRCA 1 and 2 genesIncreased number of ovulations Obesity Smoking

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98
Q

What are the protective factors for ovarian cancer? (3)

A

Oral contraceptive pillPregnancyBreastfeeding Early menopause

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99
Q

What is the presentation of ovarian cancer? (5)

A

Abdominal pain Bloating Early satietyLoss of appetite Pelvic pain Weight lossAbdominal or pelvic massAscites

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100
Q

When should someone be referred on a 2 week wait? (Ovarian cancer)

A

Ascites Pelvic massAbdominal mass

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101
Q

What are the initial investigations for ovarian cancer?

A

CA-125 Pelvic ultrasound

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102
Q

What other investigations may be performed for diagnosis of ovarian cancer? (3)

A

CT scan Laparotomy for biopsy Alpha fetoprotein and beta hCGAscitic tap to look for cancer cells

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103
Q

What are the other causes of a raised CA-125? (5)

A

EndometriosisFibroidsPelvic infection Liver diseasePregnancy AdenomyosisAscites Endometrial cancer, breast cancer, metastatic lung cancer Menstruation

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104
Q

What is the staging of ovarian cancer?

A

Stage 1 - Confined to the ovary Stage 2 - Spread from the ovary but still inside the pelvis Stage 3 - Spread past the pelvis, but inside the abdomen Stage 4 - Spread outside the abdomenA - confined to one ovary B - Both ovaries

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105
Q

What is the management of ovarian cancer?

A

Surgery - Removal of ovaries, fallopian tubes and uterus Chemotherapy

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106
Q

Where does ovarian cancer commonly metastasise to?

A

Liver Lung

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107
Q

What is endometriosis?

A

Endometriosis is a condition where there is ectopic endometrial tissue outside of the uterus

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108
Q

What are the features of endometriosis? (5)

A

Abdominal or pelvic pain (cyclical)
Deep dyspareunia
Dysmenorrhoea
Infertility
Cylical urinary and bowel symptoms
Cyclical bleeding from other areas

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109
Q

What might be seen on examination of someone with endometriosis? (3)

A

Endometrial tissue in the vagina
Fixed cervix
Tenderness in the vagina, cervix and adnexa

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110
Q

What is the gold standard investigation of endometriosis?

A

Laparascopic surgery and biopsy of lesions

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111
Q

What is the initial investigation in patients with symptoms of endometriosis and what does it show?

A

Trans-vaginal ultrasound - often normal

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112
Q

What are the differentials of endometriosis? (3)

A

AdenomyosisInterstitial cystitis PIDIBS Ovarian cyst Ovarian cancer

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113
Q

What is the medical management of endometriosis? (5)

A

Analgesia - paracetamol or NSAIDsHormonal therapies - Combined OCP- Progesterone only pill- Depo injection GnRH agonists Mirena coil

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114
Q

What are the surgical management options for endometriosis?

A

Laparascopic surgery to ablate or excise endometrial tissueHysterectomy

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115
Q

What do GnRH agonists do in endometriosis?

A

Essentially induce menopause

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116
Q

How long must symptoms have persisted for a diagnosis of endometriosis?

A

Cyclical or continuous pain for over 6 months

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117
Q

Where is endometrial tissue commonly found outside of the uterus? (3)

A

Pouch of douglas Ovaries Uterosacral ligaments

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118
Q

What is an endometrioma?

A

A cystic lesion that stems from endometriosis

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119
Q

What is the appearance of endometriomas?

A

Cysts filled with dark brown endometrial fluid commonly found on the ovaries

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120
Q

What is the management of endometriomas?

A

Laparoscopic ovarian cystectomy with excision of the cyst wall

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121
Q

What is the definition of miscarriage?

A

The spontaneous loss of pregnancy prior to 24 weeks gestation

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122
Q

What is defined as early and late miscarriage?

A

Early - before 12 weeks Late - 12-24 weeks

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123
Q

What is a missed miscarriage?

A

Fetus is no longer alive, but there were no symptoms of miscarriage

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124
Q

What is a threatened miscarriage?

A

Vaginal bleeding with a closed cervix, and a fetus that is still alive

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125
Q

What is an inevitable miscarriage?

A

Vaginal bleeding with an open cervix

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126
Q

What is an incomplete miscarriage?

A

Retained products of conception remain in the uterus after miscarriage

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127
Q

What is a complete miscarriage?

A

A full miscarriage has occurred and there are no products of conception that remain in the uterus

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128
Q

What is an anembryonic pregnancy?

A

A gestation sac is present but contains no fetus

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129
Q

What is the investigation of choice for diagnosis of a miscarriage?

A

Transvaginal ultrasound

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130
Q

What other investigation is useful in diagnosis of miscarriage?

A

Beta hCG levels

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131
Q

What features on ultrasound will a sonographer look for to determine if a pregnancy is viable?

A

Fetal heartbeat Fetal pole and crown-rump length Mean gestational sac diameter

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132
Q

What is the definition of recurrent miscarriage?

A

The loss of 3 or more consecutive pregnancies

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133
Q

When would a fetal heartbeat be detectable?

A

When crown-rump length is more than 7mm

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134
Q

What is a fetal pole?

A

When the margin of the yolk sac thickens

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135
Q

When would a fetal pole be expected to develop?

A

When crown-rump length is 25mm

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136
Q

What is the main differential diagnosis for miscarriage?

A

Ectopic pregnancy

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137
Q

What are the fetal causes of miscarriage?

A

Placental failureAbnormal development Genetic disorders

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138
Q

What are the maternal causes of miscarriage? (3)

A

PCOS Poorly controlled diabetesUterine abnormality Poorly controlled thyroid disease Anti-phospholipid syndrome

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139
Q

What are the three management routes for miscarriage?

A

Expectant management Medical management Surgical management

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140
Q

What is expectant management of miscarriage?

A

Giving 1-2 weeks for miscarriage to occur naturally Pregnancy test after 3 weeks to confirm pregnancy has ended

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141
Q

What is the medical management of miscarriage?

A

Misoprostol (given as a suppository, or orally) to quicken the process of miscarriage

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142
Q

What is misoprostol?

A

Misoprostol is a prostaglandin analogue - it binds to prostaglandin receptors to soften the cervix and stimulate contractions

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143
Q

What are the surgical management options of miscarriage?

A

Manual vacuum aspiration under local anaesthetic Electric vacuum aspiration under general anaesthetic

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144
Q

What is the presentation of miscarriage?

A

Vaginal bleeding Vaginal tissue lossPain - worse than normal period pain

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145
Q

What are the features of PCOS? (5)

A

OligomenorrhoeaSubfertility Hirtuism Obesity Mood swings and depression Male pattern baldnessAcanthosis nigricans

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146
Q

What is the definition of oligomenorrhoea?

A

Infrequent, and irregular menstruation

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147
Q

What is the Rotterdam criteria?

A

2 of the 3 criteria are required for a diagnosis of PCOS:- Polycystic ovaries - more than 12 cysts seen on imaging or ovarian volume > 10cm cubed- Hyperandrogenism - hirtuism or acne - Oligoovulation or anovulation (presenting as irregular or infrequent periods)

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148
Q

What are alternative causes of hirtuism? (3)

A

Medications Ovarian or adrenal tumours (that secrete androgens)Cushing’s syndrome Congenital adrenal hyperplasia

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149
Q

What investigations are used to help diagnose PCOS, and what are the corresponding results? (3)

A

LH/FSH ratio (more than 2)Raised LH Total testosterone (raised)Prolactin (mildly elevated)17-hydroxyprogesterone (to exclude CAH)Oral glucose tolerance testTSH

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150
Q

What is the gold standard investigation for visualising the ovaries?

A

Transvaginal ultrasound

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151
Q

What is the initial management of PCOS? (3)

A

Weight lossLow glycaemic index, calorie controlled diet ExerciseSmoking cessation

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152
Q

What are the complications of PCOS? (3)

A

Endometrial hyperplasia and cancerType 2 diabetesInfertility Depression and anxietyObstructive sleep apnoea

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153
Q

What medications might patients be started on to reduce cardiovascular complications of PCOS?

A

Antihypertensives Statins

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154
Q

What medication can be used to reduce hirtuism?

A

Co-cyprindol (combined oral contraceptive pill)

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155
Q

What medication can be used to regulate menstrual bleeding in PCOS?

A

Combined oral contraceptive pill

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156
Q

What medication can be started in PCOS to increase fertility?

A

Clomifene

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157
Q

What is the action of clomifene?

A

Increase ovulation

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158
Q

What is the second line management for increasing fertility in PCOS?

A

Laparoscopic ovarian drilling- A laser is used to damage the hormone producing cells of the ovaries - this lowers the amount of testosterone made by the ovaries

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159
Q

What is the first line treatment for the management of acne in PCOS?

A

Combined oral contraceptive pill

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160
Q

What risk factors do women with PCOS have for endometrial cancer? (3)

A

Amenorrhoea Obesity DiabetesInsulin resistance

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161
Q

How is endometrial cancer risk reduced in women with PCOS?

A

Mirena coil Inducing a withdrawal bleed via:- Combined oral contraceptive pill (with a withdrawal bleed at least once every 3 months)- Cyclical progesterone only

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162
Q

What is an ectopic pregnancy?

A

When a pregnancy is implanted outside of the uterus

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163
Q

Where is the most common site of ectopic pregnancy?

A

Fallopian tube (ampulla)

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164
Q

What are the risk factors for ectopic pregnancy? (5)

A

Previous ectopic pregnancy Previous PID Previous surgery to the fallopian tubes Having an IUDOlder age > 35SmokingEndometriosis IVFAge < 18 years on first sexual intercourse Black race

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165
Q

At what gestation does ectopic pregnancy typically present?

A

6-8 weeks

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166
Q

What are the features of ectopic pregnancy? (5)

A

Missed period Constant pain in left or right iliac fossaVaginal bleeding Lower abdominal or pelvic tendernessCervical motion tendernessShoulder tip painDizziness

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167
Q

What is the main differential of an ectopic pregnancy?

A

Miscarriage

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168
Q

What is the investigation of choice for diagnosis of an ectopic?

A

Pregnancy test Transvaginal ultrasound

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169
Q

What may be seen on transvaginal ultrasound in the investigation of en ectopic pregnancy?

A

Gestational sac in the fallopian tube Non-specific mass in the fallopian tube An empty uterus Fluid in the uterus

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170
Q

What is a pregnancy of unknown location?

A

Where a pregnancy test has confirmed a pregnancy, but there is no evidence of pregnancy on an ultrasound scan

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171
Q

What are the three management options for ectopic pregnancy?

A

Expectant management Medical management Surgical management

172
Q

What is the expectant management of ectopic pregnancy?

A

For women with few symptoms - await natural termination, and follow up with beta hCG levels

173
Q

What is the medical management of ectopic pregnancy?

A

A one off dose of IM methotrexateFollow up to check B-hCG levels falling

174
Q

What are the surgical management options of ectopic pregnancy?

A

Laparoscopic salpingectomy - removal of affected fallopian tube and ectopic pregnancy Laparoscopic salpingotomy - removal of the ectopic pregnancy, preserving the fallopian tube

175
Q

What are the signs of an advanced ectopic pregnancy? (4)

A

Patient in significant amount of pain Adnexal mass size of >35mmB-hCG levels > 5000Ultrasound identifies a fetal heartbeat All of these are indication for surgical management

176
Q

What are the other differentials of ectopic pregnancy? (3)

A

Acute appendicitis Ovarian torsion PID UTI Ruptured corpus luteum cyst

177
Q

What is atrophic vaginitis?

A

Dryness and atrophy of the vaginal mucosa due to a lack of oestrogen

178
Q

Why does atrophic vaginitis occur?

A

During menopause, a reduction in oestrogen causes the vaginal mucosa to become thinner, less elastic and drier - this tissue is more prone to inflammation

179
Q

In what age does atrophic vaginitis occur?

A

Women entering the menopause

180
Q

What is the presentation of atrophic vaginitis? (3)

A

Vaginal dryness
Itching
Dyspareunia
Bleeding
Frequent UTIs
Stress incontinence

181
Q

What will be seen on vaginal examination in a woman with atrophic vaginitis? (3)

A

Pale mucosaThin skin Reduced skin folds Erythema and inflammation Dryness

182
Q

What is the management of atrophic vaginitis?

A

Lubricants and topical oestrogen

183
Q

What forms does topical oestrogen come in?

A

PessaryCreamTablets Ring

184
Q

What is the most common cause of post-menopausal bleeding?

A

Atrophic vaginitis

185
Q

What type of tumour are most cervical cancers?

A

Squamous cell carcinoma

186
Q

What is the second most common type of cervical cancer?

A

Adenocarinoma

187
Q

What virus is heavily associated with cervical cancer?

A

Human papillomavirus

188
Q

What strains of HPV is cervical cancer primarily associated with?

A

HPV 16, 18 (and 33)

189
Q

How does HPV cause cervical cancer?

A

HPV produces the E6 and E7 oncogenes E6 oncogene inhibits the p53 suppressor gene E7 oncogene inhibits the pRB supppressor gene

190
Q

What are the risk factors for cervical cancer? (5)

A

HPV types 16, 18 and 33Smoking HIVEarly first intercourseMany sexual partnersHigh parity Long term combined contraceptive pill use

191
Q

What is the presentation of cervical cancer?

A

Abnormal vaginal bleeding Vaginal dischargePelvic pain Dyspareunia

192
Q

What is the first line investigation of cervical cancer?

A

Vaginal examination and urgent colposcopy

193
Q

What is colposcopy?

A

Colposcopy is an imaging technique using a colposcope, where the cervix is magnified which allows the epithelial lining to be examined

194
Q

What other investigations are useful in the diagnosis of cervical cancer? (3)

A

BiopsyHPV testing FBC CT chest/abdo/pelvis

195
Q

How is epithelial dysplasia graded?

A

CIN (cervical intraepithelial neoplasia) 1 - mild dysplasia, affecting 1/3 of the thickness of the epithelium CIN 2 - moderate dysplasia, affecting 2/3 of the thickness of the epithelium CIN 3 - severe dysplasia - likely to turn into cancer if untreated

196
Q

At what age is cervical screening offered?

A

25-64

197
Q

How often are women screened for cervical cancer?

A

Every 3 years for those 25-49Every 5 years for those 50-64

198
Q

What is dyskaryosis?

A

Abnormal cervical cells detected on a cervical smear

199
Q

How are cervical smear results interpreted?

A

HPV negative - return to normal recall HPV positive and normal cytology - repeat HPV test in 12 months HPV positive and abnormal cytology - refer for colposcopy

200
Q

What is the treatment of cervical intraepithelial neoplasia to prevent cancer?

A

LLETZ procedure (large loop excision of the transformation zone)

201
Q

What is a LLETZ procedure?

A

A loop of wire with electrical current removes abnormal cervical tissue. This can be performed under local anaesthetic during colposcopy

202
Q

What is the staging of cervical cancer?

A

Stage 1 - Confined to the cervix Stage 2 - Invades the uterus or upper 2/3 of the vagina Stage 3 - Invades the pelvic wall or lower 1/3 of the vagina Stage 4 - Invades the bladder, rectum or beyond the pelvis

203
Q

What is the different between stage 1A and 1B cervical cancer?

A

Stage 1A is only visible by microscopy and is less than 7mm large, whereas stage 1B is clinically visible, or more than 7mm

204
Q

What is the treatment of cervical cancer?

A

CIN or stage 1A - LLETZ procedure or cone biopsyStage 1B- 2A - radical hysterectomy and removal or local lymph nodes Stage 2B-4A - Chemotherapy and radiotherapy Stage 4B - combination of chemo, radiotherapy and surgery

205
Q

What is a cone biopsy?

A

A procedure that involves moving a small, cone shaped piece of the cervix

206
Q

To who and when is the HPV vaccine given to?

A

The HPV vaccine is given to boys and girls aged 12 and 13 (before they become sexually active)

207
Q

When should a patient be recalled if they have a +ve HPV screen, and is -ve after a 12 month follow up?

A

Return to normal recall

208
Q

When should a patient be recalled if they have two +HPV screens, but cytology is normal for both?

A

Recall after 12 months

209
Q

What should be done if a patient has +HPV screen with normal cytology after two follow up 12 month screens?

A

Refer for colposcopy

210
Q

When should a patient who has had treatment for CIN next have a cervical smear?

A

6 months after treatment

211
Q

What is lichen sclerosus?

A

A chronic inflammatory condition that presents with patches of white, shiny patches of skin

212
Q

What is the presentation of lichen sclerosus? (3)

A

Vaginal itching Burning and soreness of the vulva Skin tightnessDyspareunia Erosions and fissures

213
Q

What is the appearance of the labia in lichen sclerosus? (3)

A

Porcelain white in colour Shiny Tight Thin Slightly raised Papules or plaques

214
Q

What is the definitive investigation for diagnosis of lichen sclerosus?

A

Biopsy (but diagnosis is usually made clinically)

215
Q

What is the most serious complication of lichen sclerosus?

A

Vuval cancer (squamous cell carcinoma)

216
Q

What is ovarian torsion?

A

A gynaecological emergency where the ovary twists in relation to the fallopian tube, connective tissue and blood supply

217
Q

What is the main cause of ovarian torsion?

A

A mass larger than 5cm (for example a cyst or tumour)

218
Q

In which women does ovarian torsion occur in? When is it more common?

A

Mainly occurs in women of reproductive age
More common during pregnancy
Can occur in young girls before menarche

219
Q

What is the pathophysiology of ovarian torsion?

A

Twisting of the adnexa (fallopian tube and ovary) leads to ischaemia. Necrosis can occur if the torsion is prolonged

220
Q

What is the presentation of ovarian torsion?

A

Sudden onset severe unilateral pelvic pain Nausea and vomiting

221
Q

What are the risk factors for ovarian torsion? (3)

A

Previous ovarian torsionPregnancyOvarian hyperstimulation PCOS Benign or malignant ovarian cysts

222
Q

What are the differentials of ovarian torsion? (3)

A

Ectopic pregnancy Ruptured graafian follicle Urolithiasis PID AppenditicitisFunctional ovarian cystsEndometriosis UTI

223
Q

What is the first line investigation for ovarian torsion?

A

Transvaginal ultrasound

224
Q

What signs may be seen on transvaginal ultrasound in someone with ovarian torsion? (2)

A

Whirlpool sign Free fluid in the pelvis Oedema around the ovary

225
Q

What is the definitive investigation for someone with ovarian torsion?

A

Laparascopic surgery

226
Q

What other investigations are performed to help diagnose ovarian torsion? (3)

A

Pregnancy test Urinalysis FBC CRP CT abdo/pelvis

227
Q

What is the management of ovarian torsion?

A

Laparoscopic detorsion Laparoscopic oophorectomy

228
Q

What are the complications of ovarian torsion? (3)

A

Rupture - peritonitis, adhesions Infertility if only functioning ovary Abscesses - sepsis

229
Q

What is the most common type of vulval cancer?

A

Squamous cell carcinoma

230
Q

What is the presentation of vulval cancer? (3)

A

Lump with or without lymphadenopathy Itching Non-healing ulcer Vulval pain BleedingChanges to vulval skin

231
Q

Where does vulval cancer most commonly affect?

A

Labia majora

232
Q

What are the risk factors for vulval cancer? (3)

A

Advanced age
Immunosuppression
HPV infection
Lichen sclerosis

233
Q

What is the pre-malignant condition of vulval cancer?

A

Vulval intraepithelial neoplasia

234
Q

What are the treatment options for VIN? (3)

A

Watch and wait Excision of lesion Imiquimod cream Laser ablation

235
Q

What is the definitive investigation for vulval cancer?

A

Examination of vulva and 2 week urgent referralBiopsy

236
Q

What further investigations will be performed once vulval cancer is diagnosed? (2)

A

Sentinel node biopsy to determine lymph node involvement CT abdo pelvis for staging

237
Q

What is the treatment of vulval cancer?

A

Wide local excision Groin lymph node dissection Chemotherapy Radiotherapy

238
Q

What is adenomyosis?

A

Adenomyosis refers to endometrial tissue inside the myometrium

239
Q

Who is adenomyosis more common in?

A

Later reproductive years Women who have had multiple children (multiparous)

240
Q

What is the presentation of adenomyosis? (3)

A

Menorrhagia Dysmenorrhoea DyspareuniaCan be asymptomatic

241
Q

What is the first line investigation of adenomyosis?

A

Transvaginal ultrasound

242
Q

What other investigations may be performed to diagnose adenomyosis?

A

MRI Transabdominal ultrasound

243
Q

What is the definitive investigation for diagnosis of adenomyosis?

A

Histological examination of uterus after hysterectomy

244
Q

What is the management of adenomyosis?

A

Symptomatic relief:Tranexamic acid for menorrhagia with no pain Mefenamic acid for menorrhagia with pain Contraception:Mirena coil GnRH analoguesHysterectomy

245
Q

What is a molar pregnancy?

A

A benign tumour of trophoblastic material that grows in the uterus like a pregnancy

246
Q

What is a complete mole?

A

When a sperm cell fertilises an empty egg

247
Q

What is a partial mole?

A

When two sperm cells fertilise a normal ovum

248
Q

What is the presentation of a molar pregnancy vs a normal pregnancy? (3)

A

More severe morning sickness
Vaginal bleeding
Increased enlargement of the uterus
Abnormally high hCG
Thyrotoxicosis

249
Q

What are the first line and definitive investigations of a molar pregnancy? (3)

A

Transvaginal ultrasound, bHCG levels
Histology of the mole after evacuation

250
Q

What is the management of a molar pregnancy?

A

Evacuation of the mole by surgical curettageMonitoring of hCG

251
Q

How is hCG monitored in a complete molar pregnancy?

A

Monthly hCG samples are sent for 6 months following evacuation

252
Q

How is hCG monitored in a partial molar pregnancy?

A

A hCG sample is sent 4 weeks later - if this is normal, the patient is discharged

253
Q

What is the karyotype of a complete mole?

A

XX - diploid

254
Q

What is the karyotype of a partial mole?

A

XXY or XXX - triploid

255
Q

What is Asherman’s syndrome?

A

A condition where adhesions form in the uterus following damage to the uterus

256
Q

What is the most common cause of Asherman’s syndrome?

A

Dilatation and curettage procedure to evacuate retained products of conception after birth or msicarriage

257
Q

What are the other causes of Asherman’s syndrome?

A

Other uterine surgeries
After pelvic infections

258
Q

What is the presentation of Asherman’s syndrome? (3)

A

Secondary amenorrhoea Lighter periods Dysmenorrhoea May present with infertility Patients may have has D&C procedure, uterine surgery or endometritis

259
Q

What is the gold standard investigation for Asherman’s syndrome?

A

Hysteroscopy - adhesions can be identified and treated

260
Q

What other investigations can be performed to diagnose Asherman’s syndrome?

A

Hysterosalpinography - contrast injected into uterus and X-rayed Sonohysterography MRI

261
Q

What is the management of Asherman’s syndrome?

A

Removal of the adhesions during hysteroscopy

262
Q

What is dysfunctional uterine bleeding?

A

Menorrhagia that has no pathological cause, or bleeding between monthly periods, or prolonged bleeding

263
Q

What are the other causes of menorrhagia? (5)

A

FibroidsEndometriosis PCOS PID Contraceptives Bleeding disordersEndometrial cancer Anticoagulant medicationsAdenomyosis

264
Q

What investigations should be performed in someone with heavy menstrual bleeding?

A

FBC for iron deficiency anaemia Bimanual pelvic examination Speculum examination

265
Q

What investigations may be performed in someone with heavy menstrual bleeding? (4)

A

Transvaginal ultrasound
Hysteroscopy
Swabs
Coagulation screen
TFT
Ferritin

266
Q

What is the non-hormonal management of dysfunctional uterine bleeding?

A

Tranexamic acid if there is no associated pain Mefenamic acid if there is associated pain

267
Q

What is the first line hormonal management of dysfunctional uterine bleeding?

A

Mirena coil

268
Q

What are the second line hormonal management options for dysfunctional uterine bleeding?

A

COCP Cyclical oral progestogens e.g norethisterone

269
Q

What are the third line management options for dysfunctional uterine bleeding?

A

Endometrial ablation Hysterectomy

270
Q

What is the definition of menorrhagia?

A

Heavy menstrual bleeding that has an impact on day to day life (or is >80ml)

271
Q

What is an ovarian cyst?

A

A fluid filled sac on the ovaries

272
Q

What are the types of ovarian cysts? (5)

A

Physiological/functional:
- Follicular cyst (MC)
- Corpus luteum cyst

Benign germ cell tumours:
-Dermoid (teratomas and torsion more likely)

Benign epithelial tumours:
-Serous cystadenoma
-Mucinous cystadenoma

273
Q

What is a follicular cyst?

A

A follicle that fails to rupture and release the egg

274
Q

What is corpus luteum cyst?

A

A corpus luteum that fails to break down when the body doesn’t get pregnant - it can fill with blood or fluid to form a cyst

275
Q

What is a dermoid cyst?

A

A benign germ cell tumour (or teratoma) that contains hair, teeth, skin and bone

276
Q

What is a serous cystadenoma?

A

Benign tumours of epithelial cells of the ovaries

277
Q

What is a mucinous cystadenoma?

A

Another benign tumour of epithelial cells in the ovaries
They can grow larger than serous cystadenomas

278
Q

What is the presentation of an ovarian cyst? (3)

A

Pelvic pain BloatingFullness in the abdomen Palpable pelvic mass

279
Q

What features suggest an ovarian malignancy? (5)

A

Bloating
Reduced appetite
Early satiety
Weight loss
Urinary symptoms
Ascites
Lymphadenopathy

280
Q

What are the risk factors for ovarian malignancy? (3)

A

Age Postmenopausal Increased number of ovulations Obesity HRT Smoking Family history (BRCA genes)

281
Q

What is the first line investigation for an ovarian cyst?

A

Transvaginal ultrasound

282
Q

What further investigations may be performed in someone with an ovarian cyst?

A

CA125
MRI or CT abdo/pelvis
hCG and alpha feto protein
Laparoscopy

283
Q

What are the differentials of an ovarian cyst? (3)

A

Ovarian cancerOvarian torsion PCOS Uterine fibroidsPID

284
Q

What is the management of simple ovarian cysts?

A

Less than 5cm - Will resolve on their own in three cycles 5-7cm- Routine referral and monitoring by ultrasound every year >7cm - Consider MRI

285
Q

What are the surgical management options of an ovarian cyst?

A

Laparotomy - ovarian cystectomy or oophorectomy

286
Q

When is an ovarian cyst likely to rupture?

A

During physical activity such as sex or exercise

287
Q

What investigation can confirm an ovarian cyst rupture?

A

Laparoscopy

288
Q

What is meig’s syndrome?

A

A rare complication of ovarian cysts

289
Q

What is the triad of symptoms in meig’s syndrome?

A

Ovarian fibroma Pleural effusion Ascites

290
Q

What is endometrial cancer?

A

A malignancy that occurs in the endometrium of the uterus

291
Q

What is the most common form of endometrial cancer?

A

Adenocarcinoma

292
Q

What are the risk factors for endometrial cancer? (5)

A

Increased ageEarlier onset of menstruation Late menopause Oestrogen only HRT Nulliparity Obesity PCOS Tamoxifen

293
Q

What are the protective factors against endometrial cancer? (3)

A

COCPMirena coil Multiple pregnancies Cigarette smoking

294
Q

What is the presentation of endometrial cancer? (7)

A

Post-menopausal bleeding Post coital bleeding Intermenstrual bleeding Menorrhagia Abnormal vaginal dischargeHaematuriaAnaemia Raised platelet countDyspareunia Pelvic pain Weight loss

295
Q

Who should be referred via an urgent 2 week wait pathway for endometrial cancer?

A

Anyone with post-menopausal bleeding

296
Q

Who should be referred for a transvaginal ultrasound to investigate for endometrial cancer?

A

Women over 55 years with:- Unexplained vaginal discharge - Visible haematuria plus raised platelets, anaemia, or elevated glucose

297
Q

What are the investigations used to diagnose endometrial cancer?

A

Transvaginal ultrasound Pipelle biopsy Hysteroscopy with endometrial biopsy

298
Q

What is measured in a transvaginal ultrasound investigating endometrial cancer?

A

Endometrial thickness - Normal endometrial thickness is <4mm post-menopause

299
Q

What staging system is used to stage endometrial cancer?

A

FIGO staging system (International federation of gynaecology and obstetrics)

300
Q

What are the different FIGO stages of endometrial cancer?

A

Stage 1 - confined to the uterus Stage 2 - Invades the cervixStage 3 - invades the fallopian tubes, vagina, ovaries or lymph nodes Stage 4 - Invades bladder, rectum or beyond the pelvis

301
Q

What are the differential diagnoses of endometrial cancer? (3)

A

Uterine fibroidsEndometrial polypsCervical cancerEndometrial hyperplasia Endometriosis

302
Q

What is the typical treatment of stage 1 and 2 endometrial cancer?

A

Total abdominal hysterectomy with bilateral salpingo-oopherectomy

303
Q

What additional treatments may be used in the management of endometrial cancer? (3)

A

Radiotherapy Progesterone to slow progression Chemotherapy Radical hysterectomy - Also involved removing lymph nodes around the area, and the top of the vagina

304
Q

What is prolactinoma?

A

A tumour of the pituitary gland that secretes excessive prolactin

305
Q

What is a microadenoma?

A

A pituitary adenoma less than 1cm

306
Q

What is a macroadenoma?

A

A pituitary adenoma larger than 1cm

307
Q

What are the features of excess prolactin in women? (3)

A

Amenorrhoea Galactorrhoea Infertility Osteoporosis

308
Q

What are the general features of a pituitary adenoma? (3)

A

Headache Visual disturbance - bitemporal hemianopia or upper temporal quandrantanopiaSigns of hypopituitarism

309
Q

What are the definitive investigations in the diagnosis of prolactinoma? (2)

A

MRI Serum prolactin

310
Q

What are the differentials of prolactinoma? (2)

A

Drug induced hyperprolactinaemiaPrimary hypothyroidismPregnancyNon-functioning pituitary adenoma

311
Q

What is the first line management for a symptomatic prolactinoma?

A

Dopamine agonists

312
Q

What dopamine agonists are commonly given for prolactinoma?

A

CarbergolineBromocriptine

313
Q

What is the second line management for prolactinoma?

A

Trans-sphenoidal adenoma resection

314
Q

When does puberty start in girls?

A

Age 8-14

315
Q

Why do obese children go through puberty earlier?

A

Adipose tissue contains aromatase that converts androgens into oestrogen

316
Q

What is tanner stage 1 in girls?

A

No pubic hair development No breast development

317
Q

What is tanner stage 2 in girls?

A

Light and thin pubic hair Breast bud development

318
Q

What is tanner stage 3 in girls?

A

Course and curly pubic hair Breast elevates beyond the areola

319
Q

What is tanner stage 4?

A

Adult like pubic hair, but not reaching the thigh Areolar mound forms and projects from surrounding breast

320
Q

What is tanner stage 5?

A

Hair extending to medial thigh Areolar mound reduces and adult breasts form

321
Q

What hormonal changes occur during puberty?

A

Growth hormone increases, causing a growth spurt GnRH begins production - causes release of FSH and LH, which causes release of progesterone and oestrogen

322
Q

When is the follicular phase of menstruation?

A

From menstruation to ovulation (first 14 days of a 28 day cycle)

323
Q

When is the luteal phase of menstruation?

A

From ovulation to the start of menstruation (the final 14 days of the cycle)

324
Q

What are the stages of development of follicles in the ovaries?

A

Primordial follicles Primary follicles Secondary follicles Graafian follicles corpus luteum corpus albicans

325
Q

How do secondary follicles develop in graafian follicles?

A

Secondary follicles develop receptors for FSH - FSH allows them to develop into graafian follicles

326
Q

What are granulosa cells?

A

Cells that sit around the oocytes and secrete oestrogen

327
Q

What causes ovulation to occur?

A

A spike in LH

328
Q

When does ovulation occur?

A

14 days before the start of menstruation

329
Q

What does the dominant follicle develop into after ovulation?

A

Corpus luteum

330
Q

What does the corpus luteum secrete?

A

High levels of progesterone and a small amount of oestrogen

331
Q

What happens when the corpus luteum is not fertilised?

A

It degenerates and stops producing oestrogen and progesterone - this causes the endometrium to break down and menstruation to occur

332
Q

What embryological structure do the female reproductive organs originate from?

A

Mullerian ducts

333
Q

Why do males not develop a uterus?

A

Male fetuses secrete anti mullerian hormone

334
Q

What is a bicornate uterus?

A

Where there are two ‘horns’ to the uterus, giving it a heart shaped appearance

335
Q

What are the complications of a bicornate uterus?

A

Miscarriage Premature birth Malpresentation

336
Q

What is an imperforate hymen?

A

Where the hymen at the entrance to the vagina is fully formed, without an opening

337
Q

When may an imperforate hymen be discovered?

A

When menstruation first occurs and blood is sealed in the vagina

338
Q

What is the clinical presentation of an imperforate hymen?

A

Cyclical pelvic pain and cramping Not associated with vaginal bleeding

339
Q

What is the treatment of an imperforate hymen?

A

Surgical incision to open the hymen

340
Q

What is a transverse vaginal septum?

A

An abnormality where a septum forms transversely across the vagina - this can be perforate or imperforate

341
Q

How is a transverse vaginal septum diagnosed?

A

Clinical examination MRI Ultrasound

342
Q

What are the complications of a transverse vaginal septum?

A

Vaginal stenosis Recurrence of the septum

343
Q

What is vaginal hypoplasia?

A

An abnormally small vagina due to failure of the mullerian ducts to develop properly

344
Q

What is the most effective emergency contraception?

A

Copper IUD

345
Q

How long after sex is a copper IUD effective for emergency contraception?

A

120 hours (5 days)

346
Q

How does the copper IUD work?

A

It prevents implantation as it is toxic to both egg and sperm

347
Q

How long can a copper IUD stay in place?

A

Up to 10 years

348
Q

What are the contraindications to the copper IUD? (3)

A

Up to 28 days postpartum Repeated history of STIs Current pelvic infection Distorted uterus Abnormal cervix Unexplained bleeding

349
Q

What is the UKMEC criteria?

A

UKMEC1 - no restriction in use UKMEC2 - benefits outweigh risksUKMEC3 - risks outweigh benefits UKMEC4 - absolute contraindication

350
Q

What contraception should women with breast cancer avoid?

A

Any hormonal contraception - Copper IUD or barrier methods are best choice

351
Q

What contraception should women with Wilson’s disease avoid?

A

Copper IUD

352
Q

What contraception should women with cervical or endometrial cancer avoid?

A

IUS

353
Q

What are diaphragms and cervical caps?

A

Silicone caps that fit across the cervix to prevent semen from entering the uterus

354
Q

How is a diaphragm/cervical cap used?

A

Fitted before sex, and left in for 6 hours after sexUsed alongside spermicide gel

355
Q

How effective is the COCP?

A

99% with perfect use 91% with typical use

356
Q

How does the COCP prevent pregnancy? (3)

A

Prevents ovulation (primary method)Progesterone thickens cervical mucus Progesterone inhibits proliferation of the endometrium

357
Q

How does the COCP prevent ovulation?

A

Oestrogen and progesterone have negative feedback on the release of GnRH from the hypothalamus In turn, less FH and LSH is released from the anterior pituitary, without which ovulation cannot occur

358
Q

What are the first line choices of progesterone for the COCP?

A

Levonorgestrel or norethisterone

359
Q

Why are levonorgestrel and norethisterone the first line choices of progesterone?

A

They have a lower VTE risk

360
Q

What is the first line COCP for PMS?

A

Yasmin - containing drospirenone

361
Q

Which is the first line COCP for acne and hirtruism?

A

Dianette - containing cyprotenone acetate

362
Q

What are the three regimes for COCP use?

A

21 days on, 7 days off 63 days on, 7 days offContinuous use

363
Q

What are the common side effects of the COCP? (3)

A

Unscheduled bleeding in first 3 months Breast pain and tendernessMood changes and depression Headaches

364
Q

What are the risks of the COCP? (4)

A

Hypertension
Small increase in risk of breast cancer, and cervical cancer
VTE
Small risk of MI and stroke

365
Q

What are the contraindications to the COCP? (4)

A

Over 35 and smoking more than 15 cigarettes per day Migraine with aura History of VTEUncontrolled hypertensionIshcaemic heart diseaseHistory of vascular disease or strokeLiver cirrhosis SLE

366
Q

What extra protection is required when starting the COCP?

A

Up to day 5 - no extra protection requiredDay 5 onwards - condoms for the first 7 days of pill taking

367
Q

What extra protection is required in the case of a missed pill?

A

If it is less than 72 hours since the last pill taken: - Take the missed pill as soon as possible - No extra action requried

368
Q

What extra protection is required in the case of more than 1 missed pill?

A

Take the missed pill as soon as possible Additional contraception needed for 7 days Day 1-7 of packet - emergency contraception neededDay 8-14 - no emergency contraception neededDay 15-21 - no emergency contraception required, but skip 7 day pill free period

369
Q

Can the COCP be used during a major operation?

A

No - the COCP should be stopped 4 weeks before a major operation

370
Q

What is the only absolute contraindication to the POP?

A

Breast cancer

371
Q

What are the two types of POP?

A

Traditional POPDesogestrel only pill

372
Q

What is the time window for taking the traditional POP?

A

3 hours

373
Q

What is the time window for taking the desogestrel only pill?

A

12 hours

374
Q

What is the mechanism of action of the traditional POP?

A

Inhibits proliferation of the endometrium Thickens cervical mucus Reduces ciliary action in the fallopian tubes

375
Q

What is the mechanism of action of the desogestrel only pill?

A

Inhibits ovulation
Inhibits proliferation of the endometrium
Thickens cervical mucus
Reduces ciliary action in the fallopian tubes

376
Q

What extra protection is needed when starting the POP?

A

No extra protection needed if started on days 1-5Day 6 onwards - additional contraception required for 48 hours

377
Q

What are the side effects of the POP? (3)

A

Unscheduled bleeding during first three months Breast tendernessHeadaches Acne

378
Q

What are the risks of the POP? (3)

A

Increased risk of ovarian cystsRisk of ectopic pregnancy with traditional POPIncreased risk of breast cancer

379
Q

What extra protection is required in the case of a missed POP pill?

A

Take the missed pill as soon as possible Use additional contraception for the next 48 hours

380
Q

How often is the progestogen-only injection given?

A

Every 12 to 13 weeks

381
Q

How long can it take for fertility to return after stopping the progestogen-only injection?

A

12 months

382
Q

What are the two types of progestogen-only injection given in the UK?

A

Depo-provera - IM injection Sayana Press - self administered SC injection

(Medroxyprogesterone acetate)

383
Q

What are UKMEC3 contraindications to the POP? (3)

A

Ischaemic heart disease and stroke
Liver disease
Unexplained vaginal bleeding

384
Q

What is the main mechanism of action of the depo injection?

A

Inhibits ovulation(also works by inhibiting proliferation of the endometrium and thickening cervical mucus)

385
Q

When is extra protection required when starting the depo injection?

A

No extra protection required before day 5 After day 5 - additional protection required for 7 days

386
Q

What are the side effects of the depo injection? (3)

A

Weight gain Acne Reduced libidoMood changesHeadaches Flushes Hair lossSkin reactions at injection sites

387
Q

What is the most important side effect of the depo injection?

A

Reduced bone mineral density

388
Q

What is the progestogen only implant?

A

A small 4cm plastic rod that is inserted underneath the skin, above the subcutaneous fat

389
Q

How long does the implant last for?

A

3 years

390
Q

What is the only UKMEC4 criteria for the implant?

A

Active breast cancer

391
Q

How does the implant work?

A

Inhibits ovulation Makes the endometrium less accepting of implantation Thickens cervical mucus

392
Q

What are the two types of coils?

A

IUD - copper containing coil IUS - levonorgestrel containing coil

393
Q

What are the contraindications to the coil? (4)

A

PID Immunosuppression Pregnancy Unexplained bleeding Pelvic cancerDistortion of the uterus by fibroids

394
Q

What are the risks relating to insertion of the coil? (3)

A

Bleeding Pain on insertion Vasovagal reactions Uterine perforationPIDExpulsion

395
Q

How long can an IUD remain in place?

A

5-10 years

396
Q

How does the IUD work?

A

Copper is toxic to ova and spermAlso makes the endometrium less accepting of implantation

397
Q

When is the copper coil contraindicated?

A

In wilson’s disease

398
Q

What are the types of IUS and how long can they be used for?

A

Mirena - 5 years Levosert - 5 years Kyleena - 5 years Jaydess - 3 years

399
Q

What other uses is the mirena coil licensed for?

A

Contraception, menorrhagia and HRT

400
Q

What other uses is the levosert coil licensed for?

A

Contraception and menorrhagia

401
Q

How does the IUS work?

A

Thickens cervical mucus Makes the endometrium less accepting of implantation Inhibits ovulation in some women

402
Q

What are the side effects of the IUS? (3)

A

Can cause spotting or irregular bleeding Pelvic pain Acne Headaches Breast tenderness

403
Q

What are the risks of the IUS?

A

Ectopic pregnancies Ovarian cysts

404
Q

What are the three types of emergency contraception?

A

Copper IUD Levonorgestrel (Levonelle)Ulipristal acetate (EllaOne)

405
Q

When can levonelle be taken?

A

Within 72 hours of unprotected sex

406
Q

When can EllaOne be taken?

A

Within 120 hours of unprotected sex

407
Q

What is the most effective form of emergency contraception?

A

Copper IUD

408
Q

What are the side effects of levonelle? (3)

A

Nausea and vomiting Spotting and changes to the next menstrual period Diarrhoea Breast tendernessDizziness Depressed mood

409
Q

What are the side effects of EllaOne? (3)

A

Nausea and vomiting Spotting and changes to the next menstrual period Back pain Mood changes Headache DizzinessBreast tenderness

410
Q

What is the Pearl Index?

A

The number of pregnancies that would be seen if 100 women used that form of contraception for one year

411
Q

At what age should a woman stop taking the COCP?

A

50 years

412
Q

When can the mirena coil or IUD be inserted after childbirth?

A

Within 48 hours of childbirth or after 4 weeks

413
Q

When can the COCP be started after childbirth?

A

After 21 daysor After 6 weeks if breastfeeding

414
Q

When can the progesterone only pill be started after childbirth?

A

Can be started at any time

415
Q

When can patients be given the copper IUD after 5 days post intercourse?

A

If the patient is up to 5 days after their earliest ovulation date

416
Q

When after childbirth is contraception needed?

A

After 21 days postpartum

417
Q

What is premature ovarian insufficiency?

A

Menopause before 40 years

418
Q

What will hormonal analysis show in someone with premature ovarian insufficency? (3)

A

High FSH (>30, 2 samples taken 4-6 weeks apart)
High LH
Low oestradiol (<100)

419
Q

What is the main cause of premature ovarian insufficency?

A

50% of cases are idiopathic

420
Q

What are the other causes of premature ovarian insufficency? (3)

A

Iatrogenic Autoimmune Genetic Infections

421
Q

What is the presentation of premature ovarian insufficiency? (3)

A

Irregular menstrual periodsHot flushes Night sweats Vaginal drynessInfertility

422
Q

What level of FSH is indicative of premature ovarian insufficency?

A

FSH> 30

423
Q

How is premature ovarian insufficency diagnosed?

A

Two FSH levels > 30 IU/L taken more than 4 weeks apart

424
Q

What are the complications of premature ovarian insufficency? (3)

A

Cardiovascular diseaseOsteoporosis Cognitive impairment Dementia Parkinsonism Stroke

425
Q

What is the management of premature ovarian insufficency?

A

HRT until age 51

Phase 3a🩺 (12 decks)

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