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Gynaecology Flashcards

1
Q

what are the risk factors for endometrial cancer?

A

1) nulliparity
2) more exposure to oestrogen (nulliparity, early menarche, late menopause, oestrogen only HRT)
3) metabolic syndrome- obesity, diabetes, PCOS
4) tamoxifen (used to treat breast ca. Blocks oestrogen receptor activity in breast, but acts like oestrogen in uterus. also increases risk of dvt)
5) HNPCC

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2
Q

what is the most common type of vulval cancer?

A

SCC

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3
Q

what are the risk factors for vulval cancer?

A

1) older age
2) smoking
3) HPV
4) VIN (vulval intraepithelial neoplasia)
5) immunosuppression
6) lichen sclerosus

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4
Q

does smoking increase the risk of endometrial cancer?

A

no, it decreases the risk because it can reduce oestrogen levels and induce endometrial apoptosis, and lead to earlier menopause

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5
Q

what is the investigation of choice for ectopic pregnancy?

A

1) Pregnancy test
2) Transvaginal USS

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6
Q

what are the criteria for being able to manage an ectopic pregnancy expectantly?

A

<35mm
asymptomatic
unruptured
no foetal heartbeat
b-hCG <1000 IU/L

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7
Q

what are the criteria for being able to manage an ectopic pregnancy medically?

A

<35mm
unruptured
no significant pain
no foetal heartbeat
b-hCG <1500 IU/L

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8
Q

what are the criteria for managing an ectopic pregnancy surgically?

A

> 35mm
pain/rupture
foetal heartbeat
b-hCG >5000IU/L

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9
Q

for ectopic pregnancy, when would you do salpingectomy vs salpingotomy if surgical intervention indicated?

A

1) salpingectomy is first line
2) salpingotomy if risk factors for infertility e.g. contralateral tube is damaged

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10
Q

how is menopause diagnosed?

A

usually a clinical diagnosis when a lady had not had a period for 12 months

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11
Q

what are contraindications for HRT?

A

1) current or past breast cancer
2) any oestrogen-sensitive cancer (endometrial, ovarian)
3) undiagnosed vaginal bleeding
4) untreated endometrial hyperplasia

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12
Q

how long do menopause symptoms typically last?

A

2-5 years

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13
Q

what risks are associated with HRT?

A

VTE
stroke
coronary heart disease
breast cancer
ovarian cancer

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14
Q

does transdermal HRT increase risk of VTE?

A

no because the oestrogen is absorbed through the skin therefore bypasses the liver = no increase in production of clotting factors in the liver

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15
Q

what are the potential complications of HRT?

A

1) side effects
- nausea, breast tenderness, weight gain

2) risks
- breast cancer (increases with duration of use, risk declines after stopping and returns to baseline 5 years after stopping)
- endometrial cancer (always give progesterone in addition to oestrogen in women with a womb to reduce risk- note doesn’t eradicate risk entirely)
- VTE (although transdermal doesn’t increase risk of VTE, should refer to haem if woman has high risk of clotting)
- stroke
- IHD if taken more than 10 years after menopause

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16
Q

what are risk factors for ovarian cancer?

A

1) more ovulations (early menarche, late menopause, nulliparity
2) family history
3) mutations in BRCA1/BRCA2

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17
Q

what is the tumour marker for ovarian cancer?

A

CA-125

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18
Q

what are BRCA 1 and 2?

A

1) tumour suppressor genes
2) mutation can cause increased risk of cancers, particularly breast and ovarian

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19
Q

what is the most common type of cervical cancer?

A

SCC

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20
Q

what are risk factors for cervical cancer?

A

1) HPV (16, 18, 33 in particular)
2) smoking
3) HIV
4) smoking
5) early first intercourse, many sexual partners
6) high parity
7) lower socioeconomic status
8) COCP

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21
Q

how does HPV cause cervical cancer?

A

HPV 16 & 18 produce oncogenes E5, E6, and E7

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22
Q

what is the difference between primary and secondary amenorrhoea?

A

primary = periods haven’t started
secondary = periods stop

1) primary
- no periods by age 15 but has secondary sexual characteristics
- or no periods by age 13 and no secondary sexual characteristics

2) secondary
- periods stop for 3-6 months in someone with previously normal periods, or 6-12 months in women with previous oligomenorrhoea

23
Q

what type of drug is duloxetine?

A

SNRI (serotonin noradrenaline reuptake inhibitor)

24
Q

how does duloxetine help manage stress incontinence

A

enhances activation of the pudendal nerve, which innervates the external urethral sphincter, allowing for stronger contraction

25
Q

what is a threatened miscarriage?

A

1) painless vaginal bleeding <24 weeks (typically 6-9 weeks)
2) closed cervical os

26
Q

what is a missed miscarriage?

A

1) gestational sac containing dead foetus <20 weeks
2) closed cervical os
3) mother may have light vaginal bleeding, usually no pain, symptoms of pregnancy disappear

27
Q

what is an inevitable miscarriage?

A

1) heavy bleeding with clots and pain
2) cervical os open

28
Q

what is an incomplete miscarriage?

A

1) not all products of conception expelled
2) pain and vaginal bleeding
3) cervical os open

29
Q

what is a miscarriage?

A

loss of pregnancy <24 weeks

most commonly occurs in first 12 weeks of pregnancy

30
Q

what is the age range for cervical cancer screening?

A

25-64 (invites sent at age 24.5)
every 3 years, then from age 50 every 5 years

31
Q

how does the cervical screening test work?

A

Now moved to a HPV first system

1) test for presence of HPV

2) HPV positive –> cytology
HPV negative –> return to normal recall

3) Cytology abnormal –> colposcopy
Cytology normal repeat HPV test in 12 months

4) sample inadequate, repeat at 3 months
2 x inadequate samples, colposcopy

5) If CIN, LLETZ

32
Q

what is Sheehan’s syndrome?

A

1) post-partum hypopituitarism
2) caused by hypovolaemic shock causing ischaemic necrosis of pituitary gland

33
Q

define premature menopause

A

onset of menopausal symptoms and elevated gonadotropin levels before the age of 40

34
Q

what causes premature ovarian insufficiency (premature menopause)?

A

1) idiopathic
- may have family history

2) bilateral oophorectomy

3) radiotherapy and chemotherapy

4) infection e.g. mumps

5) autoimmune

35
Q

how is premature ovarian failure treated?

A

HRT or COCP until age 51

36
Q

what is Asherman’s syndrome?

A

uterine/cervical adhesions leading to menstrual abnormalities, pelvic pain, infertility, recurrent miscarriage

37
Q

prior to surgery to remove a fibroid, what medication may be given?

A

GnRH agonist = less oestrogen = reduce growth of fibroid (however only used short term as mimics other symptoms of menopause too)

38
Q

what are the missed pill rules for the POP?

A

1) desogestrel (cerazette)
- if <12 hours late no action required
- if >12 hours late take missed pill asap and take next pill as usual, use condoms until pill taking has been established for 48 hours

2) traditional (non-desogestrel) e.g. micronor, noriday, femulen
- <3 hours late no action required
- >3 hours late take missed pill asap and take next pill as usual, use condoms until pill taking established for 48 hours

39
Q

how does the depo provera work?

A
  • progesterone IM injection given every 12 weeks
  • primarily inhibits ovulation
  • also thickens cervical mucus and thins endometrium
40
Q

what are adverse effects associated with depo provera?

A
  • irregular bleeding
  • weight gain
  • increased risk of osteoporosis (avoid in adolescents)
  • not quickly reversible, may have delayed return of fertility
41
Q

what is UKMEC? what are the different categories?

A

UK medical eligibility criteria (guidelines to assess which contraception is safe for a patient)

UKMEC 1 = no restrictions on use
UKMEC 2 = advantages generally outweigh risks
UKMEC 3= risks generally outweigh benefits
UKMEC 4 = unacceptable risk to health

42
Q

what is a contraindication for depo provera?

A

breast cancer (as it increases risk of breast cancer)
current breast cancer is UKMEC4, past breast cancer is UKMEC 3

43
Q

what is a contraindication to all forms of hormonal contraception?

A

breast cancer

44
Q

What are three options for emergency contraception

A

1) levonorgestrel
2) ulipristal
3) IUD

45
Q

how does levonorgestrel work as emergency contraception?

A
  • inhibits ovulation and implantation
  • must be taken within 72 hours of UPSI
46
Q

how does ulipristal (EllaOne) work as emergency contraception?

A
  • inhibits ovulation
  • must be taken within 120 hours (5 days) of UPSI
  • caution in severe asthma
47
Q

how does the IUD work as emergency contraception?

A
  • toxic to sperm
  • insert within 5 days of UPSI
48
Q

what are the missed pill rules for the COCP?

A
  • 1 missed pill = take missed pill then continue taking pills as usual
  • 2 missed pills = take missed pill then continue taking pills as usual and use condoms/abstain from sex until taken pills for 7 days in a row
  • if 2 pills missed in week 1 (day 1-7), emergency contraception
  • week 3 (day 15-21) omit pill free interval
49
Q

COCP gives increased risk of (1) and (2), but is protective against (3) and (4)

A

increased risk breast and cervical cancer

protective against ovarian and endometrial cancer (as fewer ovulations)

50
Q

does the COCP cause weight gain?

A

some users report this however a Cochrane review didn’t show any causal relationship

51
Q

what are adverse effects of the COCP?

A

1) headache, nausea, breast tenderness
2) increased risk of cervical and breast cancer
3) increased risk of VTE, stroke, IHD

52
Q

how soon will a pregnancy test read positive?

A

take on the first day of a missed period or at least 21 days after UPSI

b-hCG starts being produced 6-10 days after conception however can be unreliable to test this early, therefore advised to take on the first day of a missed period

53
Q

what are some absolute contraindications for the COCP?

A
  • migraine with aura
  • breastfeeding <6 weeks post-partum
  • age ≥35 smoking ≥15 cigarettes/day
  • systolic 160mmHg or diastolic 95mmHg
  • vascular disease
  • current or previous hx VTE
  • major surgery with prolonged immobilisation
  • known thrombogenic mutations
  • current/previous hx of IHD
  • stroke (including TIA)
  • complicated valvular and congenital heart disease
  • current breast cancer
  • nephropathy/retinopathy/neuropathy
  • severe (decompensated) cirrhosis
  • hepatocellular adenoma
  • raynaud’s disease with lupus anticoagulant
    Positive antiphospholipid antibodies
54
Q

how doe GnRH agonists help reduce fibroid size?

A

usually GnRH increases oestrogne (more GnRH increases FSH and LH increases oestrogen), however this is when GnRH is released as intermittent pulses

when released continuously (i.e. GnRH agonist), this actually decreases FHS and LH and oestrogen

reduced oestrogen means the fibroid shrinks

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