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UL Obs And Gynae > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What are the top 3 gynecological causes of acute abdominal pain?

A
  • PID
  • Ovarian Torsion
  • Follicular cysts/Mittelschmerz

PID is associated with fever and nausea/vomiting; Ovarian torsion is characterized by acute intermittent pelvic pain; Follicular cysts cause mid-cycle pain often relieved by NSAIDs.

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2
Q

What are the associated symptoms of PID?

A
  • Fever
  • Nausea/Vomiting

PID is often linked with a history of multiple sex partners and sexually transmitted infections.

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3
Q

What is the treatment for PID?

A
  • Azithromycin + Ceftriaxone
  • PO Levofloxacin + Metronidazole for 2 weeks
  • Admit for IV antibiotics if unstable or suspected tubo-ovarian abscess

Treatment aims to cover for gonorrhea and chlamydia.

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4
Q

What is the hallmark sign of ovarian torsion?

A

Acute intermittent pelvic pain with nausea/vomiting

Patients may be scared to move due to the severity of the pain.

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5
Q

What is the diagnostic method for ovarian torsion?

A

Ultrasound and Doppler of ovarian blood supply

This helps assess blood flow to the affected ovary.

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6
Q

What are the top 2 non-gynecological causes of acute abdominal pain?

A
  • Renal Stones
  • Constipation

Renal stones may present with hematuria; constipation may cause abdominal tenderness and requires hydration and fiber.

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7
Q

What is a common presentation of interstitial cystitis?

A

Pelvic pain nearly daily with recurrent urinary tract infections

This condition often leads to a tender anterior vaginal wall.

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8
Q

What are the top 3 gynecological causes of chronic pelvic pain?

A
  • Teratoma/Dermoid cyst
  • Endometriosis/Endometrioma
  • Leiomyoma/Fibroids

These conditions can lead to significant symptoms and complications.

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9
Q

What is a teratoma?

A

A tumor made of all 3 germ layers

It can lead to struma ovarii tumor and has a risk of malignant transformation.

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10
Q

What is the treatment for endometriosis?

A
  • Surgery if >3 cm
  • Medical management with progestins or GnRh agonist

Progestins can cause endometrial tissue atrophy.

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11
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma (SCC)

SCC accounts for 90% of cervical cancer cases.

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12
Q

What screening recommendations exist for cervical cancer?

A
  • Ages 25-44: every 3 years
  • Ages 45-60: every 5 years after 2 consecutive normal results
  • High-risk: annually from age 20

High-risk groups include HIV-positive individuals and those exposed to diethylstilbestrol (DES).

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13
Q

What is the Bethesda classification for cervical cytology?

A
  • LSIL (Low grade squamous intra-epithelial lesion)
  • HSIL (High grade squamous intra-epithelial lesion)
  • Atypical squamous cells (ASC)

LSIL includes HPV-associated changes; HSIL indicates moderate/severe dyskaryosis.

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14
Q

What is the main risk factor for endometrial cancer?

A

Excessive unopposed estrogen stimulation

This significantly increases the risk of developing endometrial cancer.

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15
Q

What are the common symptoms of endometrial cancer?

A
  • Postmenopausal bleeding (PMB)
  • Abnormal vaginal discharge
  • Intermenstrual bleeding (IMB)

These symptoms often lead to further evaluation and diagnosis.

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16
Q

What is the treatment for ovarian cancer?

A
  • Surgery
  • Staging
  • Chemotherapy

Surgical options include total abdominal hysterectomy and salpingo-oophorectomy.

17
Q

What are the common presentations of ovarian cancer?

A
  • Vague lower abdominal pain
  • Abdominal distension
  • Early satiety
  • GI complaints in advanced stages

Symptoms often become apparent in later stages of the disease.

18
Q

What is the FIGO staging for cervical cancer?

A
  • Stage 1: Confined to cervix
  • Stage 2: Involves proximal 2/3 of vagina
  • Stage 3: Spread in pelvis
  • Stage 4: Distant spread

Staging helps determine treatment options and prognosis.

19
Q

What is the primary treatment for CIN ≥II?

A

LLETZ (Large Loop Excision of the Transformation Zone)

This procedure is often performed to remove dysplastic cells.

20
Q

What is the peak incidence age for epithelial ovarian tumors?

A

56-60 years

Epithelial tumors are the most common type of ovarian cancer.

21
Q

What is the recommended annual screening for endometrial cancer?

A

TVUS and endometrial biopsy

TVUS stands for transvaginal ultrasound.

22
Q

When should a hysterectomy and BSO be performed for endometrial cancer?

A

When family is complete

BSO stands for bilateral salpingo-oophorectomy.

23
Q

What are the protective factors against endometrial cancer?

A
  • COCP
  • POP
  • Cigarette smoking
24
Q

What are common presentations of endometrial cancer?

A
  • PMB (postmenopausal bleeding)
  • Abnormal or blood-stained PV discharge
  • IMB (intermenstrual bleeding) or prolonged bleeding in pre- and peri-menopausal women
  • Pelvic pain
25
Q

What is endometrial hyperplasia?

A

A precursor to endometrial cancer that presents with abnormal bleeding

Endometrial hyperplasia can be classified as simple or complex.

26
Q

What symptoms are associated with endometrial hyperplasia?

A
  • PMB
  • Endometrial cells on cervical smear
  • Perimenopausal with irregular heavy menses
  • Premenopausal with AUB (abnormal uterine bleeding) with history of anovulation
27
Q

What are the differential diagnoses for PMB?

A
  • Exogenous oestrogen use, e.g. tamoxifen
  • Atrophic endometritis/vaginitis
  • Endometrial cancer/hyperplasia
  • Other gynecological cancers
28
Q

What investigations are used to assess endometrial thickness?

A

TVUS

If the endometrial thickness is > 5mm, further investigations are needed.

29
Q

What is the significance of an endometrial thickness of 20 mm?

A

Endometrial cancer is more likely

This finding necessitates further evaluation.

30
Q

What procedures are involved in the investigation of endometrial issues?

A
  • Hysteroscopy with endometrial sampling
  • D&C (dilation and curettage)
31
Q

What is the staging of endometrial cancer?

A
  • I - Confined to uterine body (most are diagnosed here, good prognosis)
  • II - Invades cervix but not beyond uterus
  • III - Local and/or regional spread
  • IVa - Involves bladder/bowel mucosa
  • IVb - Distant metastases
32
Q

What is the most common pattern of spread for endometrial cancer?

A

Direct extension

33
Q

What are the management options for endometrial cancer?

A
  • Total hysterectomy
  • BSO
  • Peritoneal cytology
  • Selective surgical staging
34
Q

What are the indications for surgical staging in endometrial cancer?

A
  • Grade 3 lesion (poorly differentiated)
  • Grade 2 tumour >2cm
  • Adenosquamous, clear cell, and papillary serous
  • > 50% myometrial invasion
  • Cervical extension

UL Obs And Gynae (12 decks)

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