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3A > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What is Asherman’s syndrome?

A

A syndrome where adhesions form within the uterus following damage to the uterus

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2
Q

Causes of asherman’s syndrome?

A

Pregnancy related dilation and curettage procedure
Uterine surgery
Severe pelvic infection

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3
Q

Pathophysiology of ashermans syndrome

A

Endometrial curettage (scraping) can damage the basal layer of the endometrium
The damaged layer heals abnormally and can lead to adhesions forming between areas of the uterus
It can lead to the uterus being sealed shut

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4
Q

Presentation of Asherman’s syndrome

A

Following dilation and curettage, uterine surgery, endometriosis
- secondary amenorrhoea
- dysmenorrhea
- lighter periods
Can also present as infertility

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5
Q

Diagnosis of Asherman’s syndrome

A

Hysteroscopy is gold standard
Can also include hysterosalpinography and sonohysterography

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6
Q

Management of Asherman’s syndrome

A

Hysteroscopy with dissection and treatment of adhesions

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7
Q

What is atrophic vaginitis?

A

Dryness and atrophy of the vagina mucosa that is caused by lack of oestrogen after menopause

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8
Q

Presentation of atrophic vaginitis

A

Itching
Dryness
Dyspareunia
Bleeding due to local infection

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9
Q

Examination results of atrophic vaginitis

A

Pale mucosa
Thin skin
Reduced skin folds
Erythema and inflammation
Dryness
Sparse pubic hair

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10
Q

Treatment of atrophic vaginitis

A

Vaginal lubricants
Topical oestrogen -cream, pessaries

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11
Q

What is androgen insensitivity syndrome

A

A genetic condition where cells are unable to respond to androgens (testosterone) due to a lack of the androgen receptor

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12
Q

Describe patient with androgen insensitivity syndrome

A

A genetic male (46XY) with female phenotype

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13
Q

Genetics of androgen insensitivity syndrome

A

X linked recessive condition caused by mutation in the androgen receptor on the X chromosome

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14
Q

Pathophysiology of androgen insensitivity syndrome

A

Lack of androgen receptors prevents the development of male phenotype
The extra androgens are converted into oestrogen which leads to the development of secondary female sexual characteristics

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15
Q

Presentation of androgen insensitivity syndrome

A
  • primary amenorrhoea
  • lack of male facial hair, pubic hair and male muscle development
  • infertility
  • female external genitalia (wont have uterus, upper vagina, cervix, fallopian tube or ovaries as the testes produce anti-mullerian hormone which prevents development of female internal organs)
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16
Q

Two examples of how androgen insensitivity syndrome might first present

A

Inguinal hernia in infants (containing the testes)
Primary amenorrhoea at puberty.

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17
Q

Management of androgen insensitivity syndrome

A

Counselling
Bilateral orchidectomy
Oestrogen therapy

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18
Q

What is lichen sclerosis

A

A chronic inflammatory skin condition that presents as ‘shiny’ patches of ‘porcelain-white’ skin

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19
Q

Typical patient with lichen sclerosis

A

A woman aged 45 -60 with vulval itching and skin changes to the vulva

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20
Q

What is an imperforate hymen

A

A hymen which prevents the flow of flood through the vagina- cuases primary amenorrhoea
May present as a blue and building membrane with mass protruding from behind the vagina

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21
Q

How might the presentation of ovarian torsion an a rupture ovarian cyst present?

A

Both will have sudden severe pain
Ruptured cyst is more likely to have peritoneal signs like rebound tenderness and haemodynamic instability

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22
Q

Most common type of vulval cancer

A

Squamous cell carcinoma

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23
Q

What is the most common cause of post menopausal bleeding

A

Atrophic vaginitis (however consider endometrial cancer )

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24
Q

What are the most common type of uterine fibroids?

A

Intramural - confined to the myometrial layer of the uterus

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25
Q

What antibiotics should be given to someone with pelvic inflammatory disease?

A

IM ceftriaxone
oral doxycycline
Oral metronidazole

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26
Q

After how long should someone be referred for infertility

A

After 12 months of trying

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27
Q

How does vulval cancer present

A

Vulval soreness, burning, pruritis and bleeding

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28
Q

What blood test result may be suggestive of PCOS

A

A high LH to FSH ratio

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29
Q

First line management of PCOS

A

Combined oral contraceptive pill

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30
Q

Which HPV is associated with cervical cancer?

A

16 and 18

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31
Q

Which HPV are associated with genital warts

A

6 and 11

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32
Q

First line investigation for uterine fibroids

A

Transvaginal USS

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33
Q

What method of contraception can be used for up to 5 days after unprotected sex and can provide long term protection

A

Copper IUD

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34
Q

What medication can cause hyperprolactinaemia

A

Risperidone

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35
Q

What part of the vulva is most commonly affected by vulval cancer

A

Labia Majorca

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36
Q

Who does cervical cancer typically present?

A

Women of reproductive age- 25 to 29

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37
Q

Most common cause of cervical cancer

A

HPV type 16 and 18

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38
Q

How does HPV cause cervical cancer

A

IT produces 2 proteins which inhibit 2 tumour suppressor genes
E6 inhibits p53, E7 inhibits pRb

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39
Q

Risk factors for cervical cancer aside from HPV

A

Smoking, HIV, combined oral contraceptive use for >5 years, increased number of full term pregnancies, family history, exposure to diethylstilbesterol in utero

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40
Q

Presentation of cervical cancer

A

Unusual vaginal bleeding- intermenstrual, post sex, post menopausal
Dyspareunia
Vaginal discharge

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41
Q

Most common types of cervical cancer

A

Most= squamous cell carcinoma
Other- adenocarcinoma

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42
Q

How is cervical cancer diagnosed

A

If symptoms- speculum examination - if abnormal changes then colposcopy
If colposcopy positive then biopsy
May also be picked up on smear test- if smear positive- colposcopy

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43
Q

Describe colposcopy

A

A speculum is inserted and a colposcope (magnifying) is used to examine cells.
Dyes may be added: iodine (normal cells=brown), acetic acid (cancer cells = white)

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44
Q

What grading system is used for colposcopy

A

Cervical intraepithelial neoplasia (CIN) grading system

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45
Q

What does a CIN I suggest

A

Mild dysplasia covering one third of the thickness of the epithelial layer
Likely will resolve

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46
Q

What does CIN II suggest

A

Moderate dysplasia covering 2/3 of the thickness of the epithelial layer- will likely become cancerous

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47
Q

What does CIN III suggest

A

Severe dysplasia covering entire thickness
Carcinoma in situ

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48
Q

How is cervical cancer screened for?

A

Smear test

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49
Q

What 2 things does the smear test look for?

A

Presence of HPV
Abnormal cell changes - dyskaryosis
If HPV is negative it won’t test cells

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50
Q

How often is HPV screening done?

A

If 25-49 = every 3 years
If 50-64= every 5 years

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51
Q

How often should women with HIV have smear tests ?

A

Yearly

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52
Q

Should pregnant women have smear tests?

A

No- should wait until 3 months postpartum

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53
Q

If HPV is positive but cytology is negative what should happen

A

Re-smear in 12 months

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54
Q

If smear test is positive what test should be done

A

Colposcopy

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55
Q

If colposcopy is positive for cancer what test should be done?

A

Biopsy

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56
Q

What grading system is used for cervical cancer biopsy

A

FIGO

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57
Q

Stage 1 FIGO cervical cancer

A

Confined to the cervix

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58
Q

Stage 2 FIGO staging cervical cancer

A

Invades the uterus or upper 2/3 of the vagina

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59
Q

Stage 3 FIGO staging cervical cancer

A

Invades the pelvic wall or the lower 2/3 of the vagina

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60
Q

Stage 4 FIGO staging

A

Invades the bladder, rectum or beyond the pelvis

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61
Q

Treatment of CIN or early stage cervical cancer (1A)

A

Large loop excision of the transformation zone (LLETZ)
Cone biopsy

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62
Q

Treatment of stage 1B to 2A cervical cancer

A

Radical hysterectomy, local lymph node excision, chemo and radiotherapy

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63
Q

Treatment of stage 2B to 4A cervical cancer

A

Chemo and radio

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64
Q

Treatment of stage 4B cervical cancer

A

Combination surgery (potentially pelvic exenteration - removal of most/all pelvic organs)
Radiotherapy and chemo
Palliative care

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65
Q

What chemotherapy drug may be used in cervical cancer

A

Bevarizumab (avastin) - targets vascular endothelial growth factor

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66
Q

What are Nabothian cysts and how do they present

A

They are cysts on the cervix that occur when the squamous cell epithelium of the cervix slightly covers the columnar epithelium- means the mucous secreted by the columnar epithelium gets trapped
Present as yellow/amber mucous

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67
Q

What is Chandelier sign

A

Cervical motion tenderness

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68
Q

Management of ectopic pregnancy if not in significant pain, not ruptured and no visible heartbeat

A

Methotrexate

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69
Q

Management of ectopic pregnancy if ruptured, severe pain, haemodynamic instability or visible heartbeat

A

Surgery -salpingectomy or salpingotomy

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70
Q

If a mother has the BRCA 1 gene what is the likelihood of her children and siblings having the gene?

A

50%

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71
Q

What is the snow plant sign on uss of the breast

A

Rupture of an implant

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72
Q

What is adenomyosis?

A

The presence of endometrial tissue within the myometrium (the muscular layer of the uterus)

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73
Q

Who is effected by adenomyosis?

A

Predominately multiparous women towards the end of their reproductive cycle
Occurs in 10% of women overall

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74
Q

Aetiology of adenomyosis

A

Not fully understood but thought to be hormone dependent as tends to resolve with menopause

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75
Q

Presentation of adenomyosis

A

Dysmenorrhea
Menorrhagia
Dyspareunia
Can also have infertility and pregnancy related complications

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76
Q

Adenomyosis on examination

A

Enlarged boggy uterus

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77
Q

First line investigation for adenomyosis

A

Transvaginal US

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78
Q

Medical treatment of adenomyosis

A

1st line- contraception- Mirena coil
If not wanted:
- tranexamic acid (heavy bleeding)
- Mefanemic acid (pain and bleeding)
- GnRH agonist (induced menopause like state)

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79
Q

Surgical treatment of adenomyosis

A

Uterine artery embolisation
Hysterectomy

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80
Q

Pregnancy related complications of adenomyosis

A

Infertility, miscarriage, preterm birth , premature rupture of membranes

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81
Q

What is another name for uterine fibroids

A

Leiomyomas

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82
Q

Pathophysiology of uterine fibroids

A

They arise from the myometrium of the uterus- benign smooth muscle tumours

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83
Q

Three types of endometrial fibroids

A

Intramural (most common), submucosal, subserosal

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84
Q

Describe a intramural uterine fibroid

A

Confined to the myometrium of the uterus

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85
Q

Describe Submucosal fibroids

A

Arise from underneath the endometrium and protrude into the uterine cavity

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86
Q

Describe subserosal fibroids

A

Protrude and distort the serosal (outer) layer for the uterus, Can be pedunculated

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87
Q

Presentation of uterine fibroids

A
  • pressure symptoms and abdominal distention
  • heavy menstrual bleeding (menorrhagia)
  • subfertility
  • acute pelvic pain (can occur in pregnancy due to red cell degeneration were the rapidly growing fibroid undergoes necrosis
  • urinary or bowel symptoms
  • deep Dyspareunia
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88
Q

How are uterine fibroids diagnosed?

A

Transvaginal US

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89
Q

Treatment of a fibroid <3cm

A

Conservative
- Mirena coil
- Tranexamic acid
- Mefenamic acid
- progesterone contraceptives

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90
Q

Treatment of fibroids >3 cm

A

Preoperative GnRH (zolidex) to reduce size of fibroid
Surgery: myomectomy (if wanting to preserve fertility), uterine artery embolisation, hystectomy, endometrial ablation (balloon thermal ablation)

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91
Q

Complications of uterine fibroids

A

Iron deficiency anaemia
Compression of pelvic organs (recurrent UTIs, incontinence)
Subfertility
Red degeneration of the fibroid
Torsion of a pedunculated fibroid

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92
Q

Explain Red degeneration of a fibroid

A

Occurs during pregnancy as oestrogen sensitive
As the fibroid grows it can outstrip the blood supply and undergo red degeneration

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93
Q

How does red degeneration of a fibroid present

A

Low grade fever, pain and vomiting

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94
Q

RF for endometrial cancer

A

Obesity (increased adipose tissue which contains more aromitase)
T2DM
Nulliparity
Late menopause
Early menarche
Oestrogen only HRT- unopposed oestrogen
Ovarian tumours
Tamoxifen
Lynch syndrome
PCOS

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95
Q

Protective factors against endometrial cancer

A

Mirena coil
Combined oral contraceptive
Smoking

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96
Q

What is the most common type of endometrial cancer

A

Adenocarcinoma

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97
Q

How does endometrial cancer present

A

Post menopausal bleeding
Uterine mass
Abnormal menstruation in pre menopause (heavy bleeding, intermenstrual bleeding)
Abdominal pain - not common
Weight loss

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98
Q

How is endometrial cancer diagnosed

A

1st line- Transvaginal USS
Gold- Hysteroscopy and biopsy

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99
Q

Management of endometrial cancer

A

Total abdominal hysterectomy and bilateral salpingo-oophorectomy

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100
Q

What treatment may be used in frail old women who cannot have surgery for endometrial cancer

A

Progesterone therapy

101
Q

Gold standard investigation of endometriosis

A

Laparoscopic visualisation

102
Q

Who can the copper coil not be given to as emergency contraceptions?

A

Those with a suspected STI or PID

103
Q

Treatment of stress incontinence after pelvic floor exercises

A

Duloxetine

104
Q

What surgery should be used for ectopic pregnancy if the other fallopian tube is damaged?

A

Salpingotomy

105
Q

Most common side effect of the progesterone only pill

A

Irregular bleeding

106
Q

What drug is typically used to treat infertility in PCOS

A

Clomifene

107
Q

How does the copper uterine devise work?

A

Decreases sperm motility and survival

108
Q

After how many days is the IUD effective

A

Immediately

109
Q

After how many days is the IUS effective

A

7 days

110
Q

What is an IUD made of and how does it prevent pregnancy

A

IUDS are copper coils
They prevent pregnancy by decreasing sperm motility and survival

111
Q

How quickly do IUDs work?

A

Immediately

112
Q

SE of IUDs

A

Heavy menstrual bleeding

113
Q

Explain what an IUS is and how it works

A

Levonorgesterol intrauterine system
Works by preventing endometrial proliferation and causes cervical mucous thickening

114
Q

How quickly ones the IUS work?

A

After 7 days

115
Q

What is placental invasion through the perimetrium called?

A

Placenta percreta

116
Q

What ovarian pathology is associated with Rokitansky’s protuberance

A

A teratoma (germ cell tumour- dermoid cyst)

117
Q

5 criteria for expectant management of a ectopic pregnancy

A

1- unruptured embryo
2- <35mm
3- no heartbeat
4- asymptomatic
5- B-hCG less than 1,000 and declining

118
Q

At what age is premature ovarian failure

A

Before the age of 40

119
Q

What is the treatment of stress incontinence in those who do not respond to pelvic floor exercsie

A

duloxetine

120
Q

stage 1 ovarian cancer

A

confined to the ovary

121
Q

stage 2 ovarian cancer

A

outside ovary but within the pelvis

122
Q

stage 3 ovarian cancer

A

outside ovary but within the abdomen

123
Q

stage 4 ovarian cancer

A

distant metastases beyond the pelvis and abdomen

124
Q

What condition is associated with a symmetrically enlarged boggy uterus

A

adenomyosis

125
Q

what endocrine marker is typically used in the diagnosis of PCOS

A

low sex hormone binding globulin concentration

126
Q

If there is evidence of infection in an incomplete miscarriage what management should be used

A

vacuum aspiration

127
Q

What is the mechanism of oxybutynin

A

anti-muscarinic

128
Q

what is the most common side effect of the progesterone only pill

A

irregular vaginal bleeding

129
Q

How often is the depo injection given?

A

every 12 weeks

130
Q

What treatment for thrush should be used in pregnant women?

A

clomitrazole pessary (oral fluconazole is contraindicated)

131
Q

Where is the first place that ovarian cancer typically metastasies to ?

A

the para-aortic lymph nodes

132
Q

For how long after amenorrhoea does a women under 50 require contraception?

A

2 years

133
Q

For how long after amenorrhoea does a women over 50 need contraception

A

1 year

134
Q

What is Fitz-Hugh-Curtis syndrome

A

perihepatitis usually caused by pelvic inflammatory disease.

135
Q

HOw does Fitz-Hugh-Curtis syndrome present

A

right upper quadrant pain that worsens with inspiration and coughing

May have evidence of underlying PID- pain, fever, history of chlamydia etc

136
Q

most common cause of post-coital bleeding in post menopausal women

A

vaginal atrophy

137
Q

what blood test should be done in women with recurrent vaginal candidiasis

A

HbA1c

138
Q

How is mild PMS managed

A

lifestyle advice:
- exercise
- sleep
- small, balanced, frequent meals high in complex carbohydrates

139
Q

Management of moderatePMS

A

new generation COCP

140
Q

management of severe PMS

A

SSRIs - either taken continuously or during the luteal phase

141
Q

If someone takes the combined oral contraceptive pill what should they do in terms of surgery?

A

stop 4 weeks before major elective surgery - a progesterone only pill could be used instead

142
Q

What is pelvic inflammatory disease?

A

infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries and surrounding peritoneum

143
Q

RF od pelvic inflammatory disease

A

not using protection, multiple sexual partners, younger age, existing STIs, IUD

144
Q

What are some STI causes of PID

A

chlamydia (most common), c
gonorrhoea
mycoplasma

145
Q

What are some non-STI causes of PID

A

gardenella
haemophilus influenzae
e.coli

146
Q

How does PID present

A

lower abdominal pain
fever
deep dyspareunia
dysuria
menstrual irregularities
vaginal discharge
cervical excitation

147
Q

How is PID diagnosed?

A

pregnancy test to exclude ectopic
High vaginal swab- look for pus cells
NAAT for chlamydia and gonorrhoea

148
Q

How is pelvic inflammatory disease treated?

A

IM ceftriaxone + 14 days cause of oral doxycycline and oral metronidazole

149
Q

What bacteria does ceftriaxone cover in PID treatment>

A

gonorrhoea

150
Q

What bacteria does doxycycline cover in PID

A

chlamydia

151
Q

What bacteria does metronidazole cover in PID

A

gardenerella

152
Q

What complication can PID cause affecting the liver?

A

Fitzz-Hugh-Curtis syndrome

153
Q

How does Fitz-Hugh-Curtis syndrome present?

A

right upper quadrant pain and right shoulder tip pain

154
Q

pathophysiology of Fitz-Hugh-Curtis syndrome

A

Inflammation and infection of the liver capsule leading to adhesions between the liver and the peritoneum

155
Q

Can IUDs be left in in PID?

A

yes if mild

156
Q

What criteria is used to diagnose PCOS

A

Rotterdam criteria

157
Q

What are the components of the rotterdam criteria?

A

anovulation- oligo/amenorrhoea
Polycystic kidneys on USS- volume of more than 10cm or 12 cysts
Raised androgens- hirtuism and acne (or biochemical raised testosterone)

158
Q

What may bloods show in PCOS

A

raised testosterone
raised LH (presents as raised LH:FSH ratio)
raised insulin
normal oestrogen

159
Q

How is infertility in PCOS treated?

A

normalise weight- can use orlistat (lipase inhibitor)

induce ovulation (clomifene)

Metformin

gonadotrophins

160
Q

What skin change may patients with PCOS present?

A

aconthosis nigrcans - thick roughened skin around the axilla and elbows

161
Q

what is lichen sclerosis

A

a chronic inflammatory condition that usually effects the genitalia of elderly females

162
Q

how does lichen sclerosis present

A

porcelain white plaques
itching
superficial dyspareunia

163
Q

what is koebner phenomenon

A

when signs and symptoms are wose when friction is applied to it (occurs in lichen sclerosis)

164
Q

How is lichen sclerosis diagnosed?

A

usually examination but may do biopsy if uncertainty

165
Q

treatment of lichen sclerosis

A

topical potent steroids (dermovate) - used once a day for 4 weeks then gradually reduced (alternate days then twice weekly)

emollients should also be used

166
Q

what is a complication of lichen sclerosis

A

squamous cell carcinoma

167
Q

what is endometriosis

A

a condition caused by ectopic endometrial tissue outside ofthe uterus

168
Q

how common is endometriosis

A

affects around 10% of women of reproductive age

169
Q

how does endometriosis present?

A

chronic pelvic pain
secondary dysmenorrhoea
deep dyspareunia
subfertility
non gynae symptoms -urinary symptoms, dyschezia (painful bowel movements)

170
Q

how does endometriosis present on examination

A

reduced organ motility, tender nodularity in the posterior fornix and visible vaginal endometriotic lesions

171
Q

gold standard investigation of endometriosis

A

laparoscopy

172
Q

first line management of endometriosis

A

analgesia- NSAIDSn paracetamol

173
Q

treatment of endometriosis if analgesia doesnt work

A

combined oral contraceptive pill or progesterone only pill (stops ovulation and reduced endometrial thickening

174
Q

Treatment of endometriosis if analgesia and hormonal methods do not work

A

GnRH analogues (induce pseudo menopause)
surgery- laparoscopic excision and ablation of endometriosis, hysterectomy if not wanting to conceive)

175
Q

How does ovarian torsion present

A
  • sudden onset severe unilateral pelvic pain
  • nausea and vomiting
  • pain can come and go if the ovary twists and untwists
  • localised tenderness
176
Q

what does vaginal examination of ovarian torsion show

A

adnexial tenderness

177
Q

how is ovarian torsion diagnosed

A

transvaginal USS- whirlpool stool

178
Q

treatment of ovarian torsion

A

urgent detorsion and fixation- laparoscopic surgery

179
Q

complications of ovarian torsion

A

loss of function of the ovary -increased infertility
if nectrotic ovary is left then can cause an abscess and infection

180
Q

RF of ovarian torsion

A

ovarian mass (usually >5cm)
pregnancy
reproductive age
ovarian hyperstimulation syndrome

181
Q

differentials of ovarian torsion

A

appendicitis, ectopic pregnancy, rupture of an ovarian cyst

182
Q

RF for ovarian cancer

A

increasing age (peak at 60)
BRCA 1 and BRCA 2
increased number of ovulations (early menarche, late menopause, no pregnany)
obesity
smoking
clomifene use

183
Q

protective factors for ovarian cancer

A

combined oral contraceptive
breastfeeding
pregnancy

184
Q

What are the most common type of ovarian cancers

A

serous carcinomas

185
Q

Where does ovarian cancer commonly spread

A

intraperitoneal structure and organs
the liver
para-aortic lymph nodes
lung

186
Q

How does ovarian cancer present

A

vague symptoms
bloating
early satiety
pelvic pain
urinary symptoms
diarrhoea
ascities

187
Q

If ovarian cancer causes hip and groin pain which nerve has been compressed

A

obturator nerve

188
Q

Differentials for ovarian cancer

A

fibroids
ovarian cysts
IBS
constipation
other female cancers

189
Q

Tumour marker for ovarian cancer

A

CA125

190
Q

what other conditions cause a rise in CA125

A

endometriosis
menstruation
benign ovarian cysts
adenomyosis
pelvic infection
liver disease
pregnancy

191
Q

what value of CA125 is raised

A

above 35

192
Q

What index is used to estimate the risk of an ovarian mass being malignant

A

risk of malignancy index

193
Q

what components make up the risk of malignancy index

A

CA125 level
menopausal status
USS findings

194
Q

RF of vulval cancer

A

advanced age (>75)
immunosuppression
HPV
lichen sclerosis

195
Q

What is the most common type of vulval cancer

A

squamous cell carcinoma

196
Q

What are premalignant conditions that may precede vulval cancer called?

A

vulval intraepithelial neoplasia (VIN)

197
Q

What two types of VIN are there

A

high grade squamous intraepithelial lesions- associated with HPV, 35-50
differentiated VIN - associated with lichen sclerosis , 50-60

198
Q

What treatment options can be used in VIN

A

watch and wait
wide local excision
imiquimod cream - topical immune response modifier
laser ablation

199
Q

How does vulval cancer present?

A

vulval lump
ulceration
bleeding
pain
itching
lymphadenopathy

200
Q

what part of the vulva is most commonly affected by vuvlal cancer

A

the labia majora

201
Q

How is vulval cancer diagnosed?

A

biopsy under 2 week wait
sentinel node biopsy
CT scan

202
Q

How is vulval cancer treated

A

wide local excision, groin lymph node dissection, chemo and radiotherapy

203
Q

what is a prolactinoma

A

a benign pituitary adenoma which secretes excess prolactin hormone

204
Q

presentation of a prolactinoma in women

A

amenorrhoea
infertility
galactorrhoea
osteoporosis

symptoms of mass- headache, bitemporal hemianopia, symptoms of hypopituitarism

205
Q

How does a prolactinoma present in men

A

impotence
loss of libido
galactorrhea
symptoms of mass

206
Q

How are prolactinomas diagnosed?

A

MRI

207
Q

What is the treatment of prolactinomas

A

dopamine agonists- cabergoline. bromocriptine
surgery

208
Q

what causes continuous urinary dribbling incontinence after birth

A

vesicovaginal fistula

209
Q

What is menopause

A

permanent cessation of menstruation at the end of the reproductive life due to loss of ovarian follicular activity

210
Q

what is the average age of menopause?

A

51

211
Q

hormonal changes associated with menopause

A

oestrogen and progesterone levels are low due a lack of ovarian follicular function

LH and FSH are high

212
Q

presentation of menopause

A

oligomenorrhoea/ amenorrhoea
night sweats
weight gain
hot flushes
joint pain
vaginal dryness and atrophy
emotional liability and low mood
loss of libido

213
Q

When would you investigate menopause with bloods

A

if a woman is under 40 or if a woman is 40-45 with menopausal symptoms

214
Q

long term complications of menopause

A

increased osteoporosis risk
increased risk of ischaemic heart disease

215
Q

contraindications to HRT

A

current or past breast cancer
any estrogen sensitive cancer
undiagnosed vaginal bleeding
untreated endometrial hyperplasia

215
Q

3 categories of menopause treatment

A

lifestyle modifications
hormonal treatments
non hormonal treatments.

216
Q

Two types of HRT.

A

combined (oestrogen and progesterone) - used if uterus is present
unnopposed oestrogen if hysterectomy

217
Q
A
218
Q

by what two methods can HRT be given

A

orally or through skin (transdermal patch, gel)

219
Q

what non-hormonal methods can be used to treat vasomotor menopause symptoms

A

fluoxetine, citalopram or velafaxine

220
Q

what can be used to treat loss of libido in menopause

A

testosterone

221
Q

what is the most common type of vaginal cancer

A

squamous cell carcinoma
15% are adenocarcinomas

222
Q

RF for vaginal cancer

A

previous hysterectomy, previous HPV , increasing age, HIV and AIDS

223
Q

where does squamous cell vaginal cancer spread to

A

spreads superficially within the vagina and can invade the paravaginal tissues
can also spread to the lungs nad lvier

224
Q

where do vaginal adenocarcinomas spread to

A

pulmonary metastases and supraclavicular and pelvic node involvement

225
Q

how does vaginal cancer present?

A

lump in the vagina
ulcers and skim changes
vaginal bleeding and itching
vaginal discharge

226
Q

investigations for vaginal cancer

A

examination
colposcopy
CT scan

227
Q

Management of vaginal cancer

A

surgery and radiotherapy in early stage
pelvic exenteration may play a role- particularly in recurrence after radiation

228
Q

what is cystocele

A

a defect in the anterior vaginal wall which causes the bladder to prolapse backwards into the vagina

229
Q

What is rectocele

A

a defect in the posterior vaginal wall which allows the rectum to prolapse forwards into the vagina

230
Q

causes of rectocele

A

constipation- faecal loading

231
Q

What is a vaginal vault prolapse

A

occurs in women who have had a hysterectomy - the top of the vagina descends into the vagina

232
Q

RF for pelvic organ prolapse

A

multiple vaginal deliveries
prolonged and traumatic deliveries
advanced age
post menopause
obesity
chronic respiratory disease causing coughing
chronic constipation causing straining

233
Q

presentation of pelvic organ prolapse

A

a sensation of something coming down into the vagina
a dragging heavy sensation in the pelvis
urinary symptoms- incontinence, urgency, frequency, weak stream)
bowel symptoms- constipation, incontinence, urgency
Sexual dysfunction- pain, altered sensation, reduced enjoyment

234
Q

What examination is done to examine pelvic organ prolapse

A

a sim’s speculum (U shaped)- held on the anterior wall to look at rectocele, held on the posterior wall to look at cystocele

235
Q

conservative management of pelvic organ prolapse

A

physiotherapy- pelvic organ, weight loss, lifestyle changes (reduced caffeine), vaginal oestrogen cream

236
Q

management of prolapse in someone not suitable for surgery

A

vaginal pessary- ring is most common, shelf, cube, donut

237
Q

surgical management of anterior prolapse

A

anterior colporrhaphy

238
Q

surgical management of posterior prolapse

A

posterior colporrhaphy

239
Q

how soon after LLETZ is a smear done

A

6 months

240
Q

what is the most common type of ovarian cancer?

A

epithelial cell tumour

241
Q

what is the most common type of ovarian cancer in young

A

germ cell tumours

242
Q

What is a type of sex cord stromal tumour that spreads to the ovary from the GI tract

A

Krukenberg tumour

243
Q

what tumour markers may be better used in ovarian cancer in young women?

A

AFP and B-HCG

244
Q

what value of CA125 is elevated

A

above 35

245
Q

what other conditions may cause a raised CA125?

A

pregnancy
PID
endometriosis
adenomyosis
menstruation
benign cysts
liver disease

246
Q

What % of women are diagnosed with ovarian cancer after it has spread?

A

70%

247
Q
A
248
Q

If the nexplanon implant causes irregular light bleeding when first inserted, what can be given to treat ?

A

A 3 month course of the combined oral contraceptive pill

3A (33 decks)

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