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1 - MSRA > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Definition primary amenorrhoea

A

Failure to establish menstruation by;
- 15 if normal secondary sexual characteristics
- 13 if no secondary sexual characteristics

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2
Q

Definition secondary amenorrhoea

A

Cessation of menstrual for;
- 3-6 months in women with previously normal mensus
- 6-12 months in women with oligomenorrhoea

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3
Q

Causes primary amenorrhoea

A
  • Gonadal dysgenesis
  • Testicular feminisation
  • Congenital malformations of the genital tract
  • Functional hypothalamic amenorrhoea
  • Imperforate hymen
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4
Q

Causes secondary amenorrhoea

A
  • Hypothalamic amenorrhoea
  • PCOS
  • Hyperprolactinaemia
  • Premature ovarian failure
  • Thyrotoxicosis
  • Sheehan’s syndrome
  • Asherman’s syndrome
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5
Q

Cause functional hypothalamic amenorrhoea

A

Anorexia

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6
Q

Cause hypothalamic amenorrhoea

A

Secondary stress
Excessive exercise

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7
Q

What is Asherman’s syndrome

A

Intrauterine adhesions

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8
Q

Initial investigations primary amenorrhoea

A
  • Exclude pregnancy
  • FBC, U&E
  • Coeliac screen
  • TFTs
  • Gonadotrophins
  • Prolactin
  • Androgen
  • Oestradiol
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9
Q

Interpretation gonadotrophins in amenorrhoea

A

Low levels = hypothalamic cause
Raised levels = ovarian problem

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10
Q

Cause of amenorrhoea with raised androgen levels

A

PCOS

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11
Q

When is HRT useful in primary amenorrhoea

A

With primary ovarian insufficiency due to gonadal dysgenesis, e.g. Turners - prevents osteoporosis

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12
Q

What is androgen insensitivity syndrome

A

End-organ resistance to testosterone causing genotypically male children to have female phenotype

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13
Q

Inheritance androgen insensitivity syndrome

A

X-linked recessive

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14
Q

Features androgen insensitivity syndrome

A

Primary amenorrhoea
Little or no axillary and pubic hair
Undescended testes causing groin swellings

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15
Q

Diagnosis androgen insensitivity syndrome

A

Buccal smear or chromosomal analysis to reveal 46XY genotype

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16
Q

Testosterone levels in androgen insensitivity syndrome

A

After puberty, high-normal to slightly elevated for reference range for postpubertal boys

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17
Q

Management androgen insensitivity syndrome

A
  • Counselling - raise child as female
  • Bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
  • Oestrogen therapy
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18
Q

Presentation atrophic vaginitis

A
  • Vaginal dryness
  • Dyspareunia
  • Occasional spotting
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19
Q

First line treatment atrophic vaginitis

A

Vaginal lubricants and moisturisers

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20
Q

Second line treatment atrophic vaginitis

A

Topical oestrogen cream

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21
Q

Most common type of cervical cancer

A

Squamous cell

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22
Q

Symptoms cervical cancer

A
  • Abnormal vaginal bleeding - postcoital, intermenstrual, postmenopausal
  • Vaginal discharge
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23
Q

What serotypes HPV highest risk for cervical cancer

A

16, 18, 33

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24
Q

Other risk factors cervical cancer

A
  • Smoking
  • HIV
  • Early first intercourse, many sexual partners
  • High parity
  • Lower socioeconomic status
  • COCP
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25
Q

What kind of cervical cancer often not detected by screening

A

Adenocarcinoma

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26
Q

Screening age and frequency cervical cancer

A

25-49 - 3 yearly
50-64 - 5 yearly

In Scotland, 25-64 every 5 years

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27
Q

Can women over 65 be screened for cervical cancer?

A

No

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28
Q

Cervical screening in pregnancy

A

Usually delayed until 3 months post-partum unless missed screening or previous abnormal smears

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29
Q

Cervical screening if never sexually active

A

Very low risk, so may wish to opt out of screening

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30
Q

Management cervical screening if negative HPV

A

Return to normal recall

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31
Q

Management cervical screening with positive HPV with abnormal cytology

A

Colposcopy

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32
Q

Management cervical screening with positive HPV and normal cytology

A

Repeat in 12 months

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33
Q

Management cervical screening - first repeat test after positive HPV and normal cytology

A

If now HPV negative, return to normal recall
If still HPV +ve and cytology still normal - repeat test 12 months later

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34
Q

Management cervical screening - second repeat test after positive HPV and normal cytology

A

If negative - return to normal recall
If positive - colposcopy

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35
Q

Management cervical screening if sample inadequate

A

Repeat sample in 3 months
If 2 consecutive inadequate samples - colposcopy

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36
Q

Follow up patients treated for CIN

A

Screen 6 months after treatment - test of cure

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37
Q

Treatment CIN

A

Large loop excision of transformation zone

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38
Q

Cause delayed puberty with short stature

A

Turner’s syndrome
Prader-Willi syndrome
Noonans syndrome

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39
Q

Cause delayed puberty with normal stature

A

Polycystic ovarian syndrome
Androgen insensitivity
Kallmans syndrome
Klinefelters syndrome

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40
Q

What is primary dysmenorrhoea

A

Painful periods with no underlying pelvic pathology

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41
Q

Features primary dysmenorrhoea

A
  • Pain typically starts just before or within few hours of period starting
  • Suprapubic cramping, may radiate to back or down thigh
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42
Q

First line management dysmenorrhoea

A

NSAIDs, e.g. mefenamic acid, ibuprofen

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43
Q

Second line management dysmenorrhoea

A

COCP

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44
Q

When does primary dysmenorrhoea usually develop

A

Within 1-2 years of menarche

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45
Q

When does secondary dysmenorrhoea develop

A

Many years after menarche

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46
Q

When does the pain start secondary dysmenorrhoea

A

3-4 days before the onset of period

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47
Q

Causes secondary dysmenorrhoea

A
  • Endometriosis
  • Adenomyosis
  • PID
  • Copper coil
  • Fibroids
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48
Q

Management secondary dysmenorrhoea

A

Refer gynae for investigation

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49
Q

Features ectopic pregnancy

A
  • 6-8 weeks amenorrhoea
  • Lower abdominal pain - usually constant, may be unilateral
  • Vaginal bleeding - usually less than normal period, may be dark brown
  • Dizziness, fainting, or syncope
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50
Q

Features of peritoneal bleeding in ectopic pregnancy

A
  • Shoulder tip pain
  • Pain on defecation/urination
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51
Q

Abdominal findings ectopic pregnancy

A

Abnormal tenderness
Cervical excitation

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52
Q

What suggests an ectopic pregnancy in pregnancy of unknown location

A

Serum bHCG >1500R

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53
Q

Risk factors ectopic pregnancy

A
  • Damage to tubes, e.g. PID, surgery
  • Previous ectopic
  • Endometriosis
  • IUCD
  • Progesterone only pill
  • IVF
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54
Q

Investigation of choice ectopic pregnancy

A

Transvaginal USS

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55
Q

What happens in expectant management ectopic pregnancy

A

Close monitoring over 48 hours - if hCG rise or symptoms manifest, intervention

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56
Q

Criteria for expectant management ectopic pregnancy

A
  • Size <35mm
  • Unruptured
  • Asymptomatic
  • No fetal heartbeat
  • hCG <1,000
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57
Q

Criteria medical management ectopic pregnancy

A

Size <35mm
Unruptured
No significant pain
No fetal heartbeat
hCG <1,5000
Willing to attend FU

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58
Q

Indications surgical management ectopic pregnancy

A
  • Size <35mm
  • Ruptured
  • Pain
  • hCG >5000
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59
Q

What management options for ectopic pregnancy are compatible with another intrauterine pregnancy

A

Expectant or surgical

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60
Q

First line surgical option ectopic pregnancy

A

Salpingectomy

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61
Q

When to consider salpingotomy ectopic pregnancy

A

Risk factors for infertility, e.g. contralateral tube damage

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62
Q

Limitation of salpingotomy

A

1/5 patients need further treatment (methotrexate +/- salpingectomy)

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63
Q

Risk factors endometrial cancer

A
  • Excess oestrogen (nulliparity, early menarche, late menopause), unopposed oestrogen
  • Metabolic syndrome - obesity, diabetes, PCOS
  • Tamoxifen
  • Hereditary non-polyposis colorectal cancer
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64
Q

Protective factors endometrial cancer

A
  • Multiparity
  • COCP
  • Smoking
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65
Q

Features endometrial cancer

A
  • Bleeding - postmenopausal, menorrhagia, intermenstrual bleeding
  • Pain uncommon (signifies extensive disease), vaginal discharge unusual
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66
Q

Referral endometrial cancer

A

All women ≥55 with postmenopausal bleeding

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67
Q

First line investigation endometrial cancer

A

Transvaginal ultrasound - normal endometrial thickness (<4mm) has high neg predictive value

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68
Q

Investigation if USS suspicious endometrial cancer

A

Hysteroscopy with endometrial biopsy

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69
Q

First line management endometrial cancer

A

Surgery

Localised disease - total abdo hysterectomy with bilateral salpingo-oophrectomy
High risk - post-op radiotherapy

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70
Q

Treatment endometrial cancer in women not suitable for surgery

A

Progesterone therapy

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71
Q

Features endometriosis

A

Chronic pelvic pain
Secondary dysmenorrhoea
Deep dyspareunia
Subfertility
Urinary symptoms - dysuria, urgency, haematuria
Dyschezia

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72
Q

Pelvic examination findings endometriosis

A

Reduced organ mobility
Tender nodularity in posterior vaginal fornix
Visible vaginal endometriotic lesions

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73
Q

Investigation endometriosis

A

Laparoscopy

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74
Q

First line treatment endometriosis

A

NSAIDs and/or paracetamol

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75
Q

Second line treatment endometriosis

A

COCP or progestogens, e.g. medoxyprogesterone acetate

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76
Q

Referral endometriosis

A
  • Diagnostic uncertainty
  • Failure of second line management
  • If fertility a priority
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77
Q

Secondary care treatments endometriosis

A
  • GnRH analogues
  • Surgery
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78
Q

SEs GnRH analogues in endometriosis

A

Induce a ‘pseudomenopause’ due to due oestrogen levels

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79
Q

Management endometriosis if trying to conceive

A

Laparoscopic excision or ablation of endometriosis plus adhesiolysis
Ovarian cystectomy

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80
Q

Definition menorrhagia

A

Total blood loss >80ml/menses

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81
Q

Menorrhagia causes

A
  • Dysfunctional uterine bleeding (no underlying pathology)
  • Anovulatory cycles
  • Uterine fibroids
  • Hypothyroidism
  • Copper coil
  • PID
  • Bleeding disorders, e.g. VWD
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82
Q

Indications for transvaginal ultrasound scan in menorrhagia

A

Symptoms suggesting structural or histological abnormality:
- Intermenstrual or postcoital bleeding
- Pelvic pain
- Pressure symptoms

Abnormal pelvic exam findings

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83
Q

First line treatment menorrhagia if contraception not required

A

Mefanamic acid 500mg TDS (esp if dysmenorrhea as well), or tranexamic acid 1g TDS started on first day of period

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84
Q

Second line treatment menorrhagia if contraception not required

A

Try the other drug whilst awaiting referral

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85
Q

First line treatment menorrhagia when contraception required

A

Mirena

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86
Q

Other treatment options menorrhagia when contraception required

A

COCP
Long-acting progestogens

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87
Q

Short term option for rapid treatment of heavy menstrual bleeding

A

Norethisterone 5mg

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88
Q

SEs HRT

A

Nausea
Breast tenderness
Fluid retention and weight gain

89
Q

What conditions does HRT increase the risk of

A
  • Breast cancer
  • Endometrial cancer
  • VTE
  • Stroke
  • IHD
90
Q

Effect of addition of progesterone to HRT of risk of cancer

A

Increases risk of breast cancer
Decreases risk of endometrial cancer

91
Q

How breast cancer risk is affect by time taking HRT

A

Increased risk with increased duration of use
Risk begins to decline when HRT stopped, by 5 years is same as woman who has never taken HRT

92
Q

Effect of addition of progesterone to HRT to risk of VTE

A

Increases risk

93
Q

Which route of administration of HRT does not increase risk of VTE

A

Transdermal

94
Q

Management HRT in women at high risk of VTE

A

Should be referred to haematology (even for transdermal)

95
Q

When does HRT increase risk of IHD

A

If taken more than 10 years after menopause

96
Q

Risk factors hyperemesis gravidarum

A
  • Increases beta-hCG - multiple pregnancy, trophoblastic disease
  • Nulliparity
  • Obesity
  • Family or personal history of NVP
97
Q

When to admit hyperem

A
  • Continued N&V and unable to keep down liquids or oral anti-emetics
  • Continued N&V with ketonuria and/or weight loss, despite treatment with oral antiemetics
  • Confirmed or suspected co-morbidity

Lower threshold for admission if woman has co-existing condition, e.g. diabetes, that may be affected by N&V

98
Q

Diagnostic criteria hyperm

A
  • 5% pre-pregnancy weight loss
  • Dehydration
  • Electrolyte imbalance
99
Q

First line management hyperem

A
  • Anti histamines - oral cyclizine or promethazine
  • Phenothiazines - oral prochlorperazine or chlorpromazine
100
Q

Second line management hyperem

A
  • Oral ondansetron
  • Oral metoclopramide or domperidone
101
Q

Limitation of ondansetron hyperem

A

When used during first trimester associated with a small increased risk of cleft lip/palate - need to counsel

102
Q

Limitation metoclopramide hyperem

A

Can cause extrapyramidal side effects, so should not be used for more than 5 days

103
Q

Complications hyperem

A
  • Dehydration
  • Weight loss
  • Electrolyte imbalance
  • AKI
  • Wernicke’s encephalopathy
  • Oesophagitis, Mallory-Weiss tear
  • VTE
104
Q

Basic investigations infertility

A

Semen analysis
Serum progesterone 7 days prior to expected period (day 21 on type cycle)

105
Q

Interpretation on serum D21 progesterone

A

<16 - repeat, if consistently low refer to specialist
16-30 - repeat
>30 - ovulation

106
Q

How long after last period to use contraception?

A

12 months if >50
24 months if <50L

107
Q

Lifestyle modifications to manage hot flushes in menopause

A

Regular exercise
Weight loss
Reduce stress

108
Q

Lifestyle modifications to manage sleep disturbance in menopause

A

Avoiding late evening exercise
Maintaining good sleep hygiene

109
Q

Lifestyle modifications to manage mood changes in menopause

A

Sleep
Regular exercise
Relaxation

110
Q

Lifestyle modifications to manage cognitive symptoms in menopause

A

Regular exercise
Good sleep hygiene

111
Q

Contraindications HRT

A

Current or past breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia

112
Q

Non-HRT management of vasomotor menopausal symptoms

A

Fluoxetine, citalopram, or venlafaxine

113
Q

Non-HRT management of vaginal dryness in menopause

A

Vaginal lubricant or moisturiser

114
Q

Non-HRT management of psychological symptoms of menopause

A

Self-help groups
CBT
Antidepressants

115
Q

Treatment urogenital atrophy

A

Vaginal oestrogen

116
Q

How long to continue HRT for vasomotor symptoms

A

2-5 years (with regular attempts to stop)

117
Q

Indications for referral to secondary care in menopause management

A
  • Ineffective treatment
  • Ongoing SEs
  • Unexplained bleeding
118
Q

Menstrual phase days

A

1-4

119
Q

Follicular phase days

A

5-13

120
Q

Ovulation phase days

A

14

121
Q

Luteal phase days

A

15-28

122
Q

Histological changes during follicular phase

A

A number of follicles develop, one follicle becomes dominant around mid-follicular phase
Proliferation of endometrium

123
Q

Hormones in follicular phase

A

Rise in FSH → rise in oestradiol → rise in LH → ovulation

124
Q

Cervical mucus in follicular phase

A

Following menstruation, mucus is thick - forms plug across os
Just prior to ovulation, mucus becomes clear, acellular, low viscosity, stretchy

125
Q

Basal body temp in follicular phase

A

Falls prior to ovulation due to influence of oestradiol

126
Q

Histological changes luteal phase

A

Corpus luteum forms in ovaries
Endometrium changes to secretory lining

127
Q

Hormones in luteal phase

A

Progesterone secreted by corpus luteum - rises through luteal phase
If fertilisation doesn’t occur, corpus luteum degenerates → fall in progesterone
Oestradiol levels rise during luteal phase

128
Q

Cervical mucus in luteal phase

A

Thick, scant, tacky

129
Q

Basal body temp in luteal phase

A

Rises following ovulation

130
Q

Features threatened miscarriage

A

Painless vaginal bleeding - often less then menstruation
Cervical os closed

131
Q

Features missed miscarriage

A

Gestational sac containing dead fetus
May have light vaginal bleeding/discharge, symptoms of pregnancy disappear
Not usually pain
Cervical os closed

132
Q

What is blighted ovum/anembryonic pregnancy

A

When gestational sac >25mm and no embryonic/fetal part seen

133
Q

Features inevitable miscarriage

A

Heavy bleeding with clots and pain
Cervical os open

134
Q

Features incomplete miscarriage

A

Not all products of conception expelled
Pain and vaginal bleeding
Cervical os open

135
Q

First line treatment miscarriage

A

Expectant management (wait for spontaneous miscarriage)

136
Q

How long do you wait in expectant management for miscarriage

A

7-14 days

137
Q

When is expectant management of miscarriage not appropriate

A
  • Increased risk of haemorrhage, e.g. late in first trimester, coagulopathies, unable to have transfusion
  • Previous adverse and/or traumatic experience with pregnancy, e.g. stillbirth, miscarriage, antepartum haemorrhage
  • Evidence of infection
138
Q

Medical management missed miscarriage

A

Oral mifepristone
48 hours later - vaginal, oral, or sublingual misoprostol (unless gestational sac already passed)

139
Q

Safety netting medical management missed miscarriage

A

If bleeding not started within 48 hours of misoprostol, contact their healthcare professional

140
Q

Medical management incomplete miscarriage

A

Single dose of oral, vaginal, or SL misoprostol

141
Q

Follow up medical management of miscarriage

A

Pregnancy test after 3 weeks

142
Q

Options for surgical management miscarriage

A
  • Vacuum aspiration
  • Surgical management in theatre
143
Q

Presentation mittelschmerz

A

Sudden onset pain in eihter iliac fossa → generalised pelvic pain
Not severe, varies in duration - minutes to hours
Self limiting, resolves within 24 hours of onset

144
Q

Most common type of ovarian cancer

A

Serous carcinoma

145
Q

Risk factors ovarian cancer

A

BRCA1/2 mutations
Many ovulations - early menarche, late menopause, nulliparity

146
Q

Clinical features ovarian cancer

A
  • Abdominal distention and bloating
  • Abdominal and pelvic pain
  • Urinary symptoms, e.g. urgency
  • Early satiety
  • Diarrhoea
147
Q

Initial investigation ovarian cancer

A

CA125

148
Q

Other causes of raised CA125

A
  • Endometriosis
  • Menstruation
  • Benign ovarian cysts
149
Q

Management raised CA125

A

Urgent ultrasound of abdomen/pelvis

150
Q

Definitive diagnosis ovarian cancer

A

Diagnostic lap

151
Q

Management ovarian cancer

A

Combination of surgery and platinum based chemo

152
Q

Types of physiological ovarian cysts

A
  • Follicular (most common)
  • Corpus luteum
153
Q

Most common type of ovarian tumour in women under 30

A

Dermoid cyst (mature cystic teratoma)

154
Q

Presentation dermoid cyst

A

Usually asymptomatic
Torsion more likely than other ovarin tumours

155
Q

Types of benign epithelial tumours of ovary

A
  • Serous cystadenoma
  • Mucinous cystadenoma
156
Q

Feature mucinous cystadenoma

A

Typically large, may become massive

157
Q

Complication mucinous cystadenoma

A

If ruptures may cayse pseudomycoma peritoni

158
Q

Features suggesting benign ovarian cyst on USS

A
  • Small (<5cm)
  • Simple (unilocular)
159
Q

Management ovarian enlargement on USS in premenopausal women

A

If appears benign on ultrasound:
Repeat USS 8-12 weeks
Referral if persists

160
Q

Management ovarian enlargement on USS in postmenopausal women

A

Refer all to gynae for assessment

161
Q

Infertility treatments with highest risk ovarian hyperstimulation syndrome

A

Gonadotropin or hCG treatment

162
Q

Features mild ovarian hyperstimulation syndrome

A

Abdominal pain
Abdominal bloating

163
Q

Features moderate ovarian hyperstimulation syndrome

A

Abdominal pain
Abdominal bloating
Nausea and vomiting
Ultrasound evidence of ascites

164
Q

Features severe ovarian hyperstimulation

A

Abdominal pain and bloating, N&V
Clinical evidence of ascites
Haematocrit >45%
Hypoproteinaemia

165
Q

Features critical ovarian hyperstimulation syndrome

A

Abdominal pain and bloating, N&V
Clinical evidence of ascites
Haematocrit >45%
Hypoproteinaemia
Thromboembolism
ARDS
Anuria
Tense ascites

166
Q

Most common organism PID

A

Chlamydia trachomatis

167
Q

Other organisms PID

A

Neisseria gonorrhoae
Mycoplasma genitalium
Mycoplasma hominis

168
Q

Features PID

A
  • Lower abdominal pain
  • Fever
  • Deep dyspareunia
  • Dysuria and menstrual irregularities
  • Vaginal or cervical discharge
  • Cervical excitation
169
Q

First line treatment PID

A

Stat IM ceftriaxone + 14 days PO doxy + PO metronidazole

170
Q

Second line treatment PID

A

PO ofloxacin and PO metronidazole

171
Q

Management PID with intrauterine devices

A

Consider removal

172
Q

Complications PID

A

Perihepatitis (Fitz-Hugh Curtis syndrome)
Infertility
Chronic pelvic pain
Ectopic pregnancy

173
Q

Presentation ovarian torsion

A

Sudden onset unilateral lower abdominal pain
Onset may coincide with exercise
N&V common
Unilateral, tender adnexal mass on examination

174
Q

Features PCOS

A
  • Subfertility and infertility
  • Menstrual disturbances - oligomenorrhoea and amenorrhoea
  • Hirsuitism, acne
  • Obesity
  • Acanthosis nigricans
175
Q

Hormonal investigations PCOS

A

Raised LH:FSH ratio
Prolactin normal or mildly elevated
Testosterone normal or mildly elevated
SHBG normal to low

176
Q

Diagnostic criteria PCOS

A

Diagnose if 2 of 3 present:
- Infrequent or no ovulation
- Clinical and/or biochemical signs of hyperandrogenism
- Polycystic ovaries on USS - ≥12 follicles in one or both ovaries, and/or ovarian volume >10

177
Q

First line treatment hirsuitism in PCOS

A

COCP - third gen has fewer androgenic effects, or co-cyprindiol has anti-androgen action

178
Q

Second line treatment hisuitism in PCOS

A

Topical eflornithine

179
Q

Specialist options for treatment of hirsuitism in PCOS

A

Spironolactone
Flutamide
Finasteride

180
Q

Management infertility PCOS

A

Weight reduction if appropriate
Specialist management
Clomifene or metformin

181
Q

Most common cause post-coital bleeding

A

Cervical ectropion

182
Q

Other causes post-coital bleeding

A

Cervicitis
Cervical cancer
Polyps
Trauma

183
Q

Definition premature ovarian insufficiency

A

Onset of menopausal symptoms and elevated gonadotrophin levels before 40 years

184
Q

Most common cause premature ovarian insufficiency

A

Idiopathic

185
Q

Other causes of premature ovarian insufficiency

A

Bilateral oophrectomy
Radiotherapy
Chemotherapy
Infection, e.g. mumps
Autoimmune disorders
Resistant ovary syndrome

186
Q

Does hysterectomy with preservation of ovaries cause premature ovarian insufficiency

A

Yes

187
Q

Cause resistant ovary syndrome

A

FSH receptor abnormalities

188
Q

Hormone test findings resistant ovary syndrome

A

Raised FSH and LH levels
Low oestradiol

189
Q

Management premature ovarian failure

A

HRT or COCP until average age of menopause (51y)

190
Q

Management mild premenstrual syndrome

A

Lifestyle advice - frequent (2-3 hourly) small balanced meals rich in complex carbohydrates

191
Q

Management moderate premenstrual syndrome

A

New generation COCP, e.g. Yasmin

192
Q

Management severe premenstrual syndrome

A

SSRI - continuously or just during luteal phase (e.g. days 15-28)

193
Q

Definition recurrent miscarriage

A

3 or more consecutive spontaneous miscarriages

194
Q

Causes recurrent miscarriage

A
  • Antiphospholipid syndrome
  • Endocrine disorders - poorly controlled diabetes, thyroid disorder, PCOS
  • Uterine abnormality, e.g. uterine septum
  • Parental chromosomal abnormalities
  • Smoking
195
Q

Non-drug management of urge incontinence

A

Bladder retraining (minimum of 6 weeks)

196
Q

Drug management of urge incontinence

A

Antimuscarinics - oxybutynin, tolterodine, darifenacin

197
Q

Drug management of urine incontinence in frail elderly patients

A

Mirabegron

Avoid immediate release oxybutynin

198
Q

Non-drug management of stress urinary incontinence

A

Pelvic floor muscle training

199
Q

Surgical management stress incontinence

A

Retro mid-urethral tape

200
Q

Drug management stress incontinence

A

Duloxetine

Used if surgery is declined

201
Q

How can fibroids cause polycythaemia

A

Due to autonomous production of erythropoietin

202
Q

Options for management of menorrhagia secondary to fibroids

A
  • Levonorgestrel intrauterine system
  • NSAIDs, e.g. mefenamic acid
  • Tranexamic acid
  • COCP
  • Oral or injectable progestogen
203
Q

Limitation of use of levonorgestrel intrauterine system for management of menorrhagia secondary to fibroids

A

Cannot be used if distortion of uterine cavity

204
Q

Medical treatment to shrink fibroids

A

GnRH agonists

205
Q

Limitation use GnRH agonists in treatment of fibroids

A

Usually short term due to side effects - menopausal symptoms, loss of bone mineral density

206
Q

Surgical treatment fibroids

A
  • Myomectomy
  • Hysteroscopic endometrial ablation
  • Hysterectomy
  • Uterine artery embolisation
207
Q

Presentation vaginal thrush

A
  • Cottage cheese non offensive discharge
  • Vulvitis - superficial dyspareunia, dysuria
  • Itch
  • Vulval erythema, fissuring, satellite lesions
208
Q

First line treatment oral thrush

A

Oral fluconazole 150mg single dose

209
Q

Treatment thrush if oral contraindicated

A

Clotrimazole 500mg intravaginal pessary as single dose

210
Q

Treatment thrush if vulval symptoms

A

Topical imidazole

211
Q

Management vaginal thrush in pregnancy

A

Only local treatments - oral treatments contraindicated

212
Q

Definition recurrent vaginal candidasis

A

4 or more episodes per year

213
Q

Management recurrent vaginal candidiasis

A
  • Check compliance with treatment
  • Confirm diagnosis - HVS for microscopy and culture
  • Consider blood glucose to exclude diabetes
  • Consider use of induction-maintenance regime
214
Q

Induction maintenance regime for recurrent vaginal candidiasis

A

Induction - oral fluconazole every 3 days for 3 doses
Maintenance - oral fluconazole weekly for 6 months

215
Q

Features trichomonas

A

Offensive, yellow/green, frothy
Vulvovaginitis
Strawberry cervix

216
Q

Features discharge BV

A

Offensive
Thin
White/grey
Fishy

217
Q

Risk factors vulval carcinoma

A

HPV infection
Vulval intraepithelial neoplasia
Immunosuppression
Lichen sclerosus

218
Q

Features vulval carcinoma

A

Lump or ulcer on labia majora
Inguinal lymphadenopathy
Itching, irritation

1 - MSRA (23 decks)

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