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Gynaecology Flashcards

1
Q

Name 2 common causes of severe right lower abdominal pain other than ectopic pregnancy

A

Appendicitis
Ovarian torsion
Gallstones

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2
Q

Name 2 symptoms or signs that may make ectopic pregnancy more likely

A

Severe, constant lower abdo pain
Vaginal bleeding
6-8 weeks amenorrhoea
Peritoneal bleeding can cause shoulder tip pain
Syncope

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3
Q

Ectopic pregnancy bedside investigation

A

hCG

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4
Q

Haemodynamically stable ectopic pregnancy

Investigation?

A

Transvaginal utrasound

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5
Q

Name 2 factors predisposing to ectopic pregnancy

A

PID
Previous surgery e.g. salpingectomy
Previous ectopic
Endometriosis
IUCD

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6
Q

Name 2 sites where a fertilised ovum may implant

A

Ampulla
Ithmus

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7
Q

Surgical management of ectopic pregnancy

A

Salpingectomy (1st line for no risk factors for infertility)

Salpingotomy (risk factors such as contralateral tube damage)

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8
Q

Medical management of ectopic pregnancy

A

Methotrexate

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9
Q

Name 3 risk factors for developing hyperemesis gravidarum

A

Increased beta-hCG (multiple pregnancies, trophoblastic disease)
Nulliparity
Obesity
FH or personal history of NVP

smoking is a/w decreased incidence

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10
Q

Most important bedside investigation to perform in HG

A

Urinary ketones

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11
Q

Name 2 blood tests you would perform for HG

A

hCG
FBC (anaemia, infection)
U&E (hypokalaemia, hyponatraemia)
Blood glucose (exclude DKA if diabetic)
LFTs (exclude liver disease e.g. hepatitis)

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12
Q

Vitamins to prescribe in HG and rationale

A

Pyridoxine (Vitamin B6) to prevent wernicke’s encephalopathy

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13
Q

1st line medications to treat HG

A

Antihistamines (oral cyclizine)
Chlorpromazine

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14
Q

Ultrasound snowstorm appearance - likely diagnosis?

A

Ovarian torsion

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15
Q

Define the following terms:
1. Threatened miscarriage
2. Missed miscarriage
3. Inevitable miscarriage
4. Incomplete miscarriage
5. Complete miscarriage

A

Threatened miscarriage: closed os, vaginal bleeding, fetus HR

Missed miscarriage: closed os, no bleeding, no fetal HR

I’s are always open os
Inevitable miscarriage: bleeding before POC have passed
Incomplete miscarriage: retained POC remain after miscarriage

Complete miscarriage: no POC remain

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16
Q

2 blood tests to perform for miscarriage

A

hCG
FBC

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17
Q

1 medical management option for incomplete miscarriage

A

Single dose of misoprostol (vaginal, oral or sublingual)

OFFER ANTI-EMETICS AND PAIN RELIEF

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18
Q

Investigation of RPOC after incomplete miscarriage

A

Ultrasound

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19
Q

2 possible complications of surgical evacuation of the uterus?

A

Infection
Bleeding

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20
Q

Name 3 causes of recurrent spontaneous miscarriage

A

SLE
antiphospholipid syndrome
PCOS

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21
Q

Name 3 causes of menorrhagia

A

Uterus fibroids
Dysfunctional uterine bleeding
Hypothyroidism
IUD (copper coil)
Bleeding disorders, e.g. von Willebrand disease

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22
Q

Menorrhagia investigations

A

FBC - all women!!
Transvaginal ultrasound if symptoms e.g. intermenstrual bleeding

TFTs
clotting studies
LH and FSH

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23
Q

List 3 contraindications to the COCP

A

Smoking
Obesity
Breastfeeding
Breast cancer

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24
Q

Menorrhagia + requires contraception

A

Tranexamic acid or mefenamic acid

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25
Menorrhagia + does not require contraception
IUS (mirena) 1st line COCP
26
List 2 possible complications of a hysterectomy
Bleeding Infection Bladder damage
27
What serious diagnosis is possible in post-menopausal bleeding?
endometrial cancer
28
Name 2 risk factors for cervical cancer other than HPV
Smoking HIV Early first intercourse, many sexual partners High parity Lower SE status COCP
29
Dyskaryosis on cervical smear - what investigation will the pt be referred for?
colposcopy
30
Explain the term ectropian
abnormal cells on the cervix that migrated from the uterus
31
Name a cause of ectropian
COCP
32
Explain what CIN III is
pre-malignant cell changes highly indicative of cervical cancer
33
What procedure can completely remove CIN III
loop LERTZZ or cone biopsy
34
Name the 2 histological types of cervical cancer
Squamous cell carcinoma (80%) Adenocarcinoma (20%)
35
Investigation to assess local and distant spread of cervical invasive carcinoma
MRI PET Lymph node biopsy
36
List 2 gynaecological causes of acute left lower abdo pain
Ectopic Ovarian torsion
36
Name 2 investigations to assess acute lower left abdo pain (gynae)
Ultrasound hCG
37
What are the clinical features of ovarian torsion and how does it arise?
Often history of recent vigorous activity Sudden onset deep colicky pain Vomiting and distress
38
Pathophysiology ovarian cancer
90% are epithelial, serous
39
2 risk factors for ovarian cancer
BRCA1 or BRCA2 gene Many ovulations: early menarche, late menopause, nulliparity
40
2 investigations for ovarian cancer
CA-125 TV ultrasound
41
What is endometriosis
Growth of ectopic endometrial tissue outside of the uterine cavity
42
Name 2 sites where endometrial foci may commonly be found
Ovary Rectovaginal pouch Pelvic peritoneum
43
Name a risk factor associated with endometriosis
Age Long duration of IUCD use Smoking FH
44
Name 2 symptoms found in endometriosis
Chronic pelvic pain Secondary dysmenorrhoea (pain often starts before bleeding) Deep dyspareunia Subfertility Urinary symptoms e.g. dysuria
45
term used to describe endometrial glandular tissue found in the myometrium
Adenomyosis
46
2 complications of endometriosis
Infertility Pelvic adhesions Ruptured cysts Bowel obstruction Chronic pelvic pain
47
Name 2 findings on vaginal examination in endometriosis
Fixed, retroverted uterus Tender uterus Enlarged ovaries
48
Name 2 medical treatments for endometriosis
NSAIDs or paracetamol 1st line for symptomatic relief 2nd line: COCP or progestogens
48
Gold standard investigation for endometriosis
Laparoscopy
49
Name 2 possible surgical treatments for endometriosis
Laparoscopic removal Hysterectomy
50
Explain the difference between primary and secondary infertility
Primary: never conceived Secondary: past conception
51
Name 3 causes of infertility
Male factor (30%) Unexplained (20%) Ovulation failure Tubal damage
52
Key counselling points for infertility
Folic acid BMI 20-25 Advise regular sexual intercourse every 2 to 3 days Smoking/drinking advice
53
Basic investigations for infertility
Semen analysis Serum progesterone 7 days prior to expected next period (typical 28 day cycle this is day 21)
54
Name 1 test to assess tubal patency
Hysterosalpingography
55
Name 2 possible symptoms of PCOS
Subfertility and infertility Menstrual disturbances e.g. oligomenorrhoea and amenorrhoea Hirsutism, acne - COCP can help Obesity Acanthosis nigricans
56
Name 2 medical treatments to treat PCOS-associated infertility
Clomifene Metformin
57
IUD fitted and pt feels faint and bradycardic - likely explanation for this
Cervical shock causes a vasovagal reaction with reflex bradycardia
58
After IUD fitting, 6 days later acute lower abdo pain, purulent vaginal discharge and fever - diagnosis?
Endometritis leading to PID
59
Name 2 organisms that may be implicated in endometritis
Chlamydia trachomatis Neisseria gonorrhoea
60
How would you treat endometritis initially
Doxycycline
61
Other than endometrial cancer, name 2 other causes of post-menopausal bleeding
Atrophic vaginitis Endometrial hyperplasia Ovarian cancer
62
What is the commonest histological type of endometrial carcinoma?
Adenocarcinoma
63
Name 2 risk factors for endometrial cancer and 2 protective factors
Excess oestrogen: nulliparity, early menarche, late menopause, unopposed oestrogen Metabolic syndrome: obesity, DM, PCOS Tamoxifen Multiparity COCP Smoking
64
Name the initial imaging performed for post-menopausal bleeding
TV ultrasound
65
stage 1 and 2 endometrial cancer (tumour confined to uterus and cervix) - recommended treatment?
Total abdominal hysterectomy with bilateral salpingo-oophorectomy
66
Name 2 treatments for stage 3 + endometrial cancer
Post-operative radiotherapy
67
Name 2 sites where endometrial cancer metastasises to
Inguinal lymph nodes Lung Bone
68
Aim of cervical cancer screening programme
Screen for HPV Screen for abnormal cells indicative of pre-invasive (dyskaryosis) disease ‘cervical intraepithelial neoplasia’
69
Bacterial vaginosis risk factors
Excessive vaginal cleaning (douching, use of vaginal washes) Multiple sexual partners Smoking Recent antibiotic treatment Copper coil
70
What conditions do these swabs test for a) NAAT b) high vaginal charcoal
a) chlamydia and gonorrhoea b) BV, trichomonas, candida, GBS
71
Causative organism of chlamydia
Chlamydia trachomatis
72
Causative organism of syphillis
Treponema pallidum
73
3 signs or symptoms of PID
Pelvic pain Deep dyspareunia Post coital bleeding Adnexal tenderness Cervical motion tenderness Fever
74
2 investigations recommended by NICE for PCOS
Pelvic ultrasound LH:FSH, prolactin, TSH, testosterone (normal or markedly raised), SHBG (normal to low) Check for impaired glucose tolerance
75
Criteria used for diagnosis of PCOS
Rotterdam: Infrequent ovulation Clinical signs of hyperandrogonism Polycystic ovaries on USS
76
Impact of PCOS on oestrogen and progesterone and how this relates to endometrial cancer
Women with PCOS ovulate infrequently so do not produce enough progesterone (progesterone is released after ovulation from the corpus luteum) - but they continue to produce oestrogen (thickened womb) Irregular menstruation means that the endometrial lining does not shed regularly This results in endometrial hyperplasia and increases the risk of endometrial cancer
77
3 clinical features of malignant breast cancer
Lesion is painless, non-tender, hard irregular Peau d'orange Redness around nipple New nipple inversion
78
What is triple assessment in breast clinic
Examination Imaging Biopsy
79
3 pieces of histological information the MDT will require for treatment planning
Tumour size Tumour grade Lymph node involvement Oestrogen receptor status HER2 status
80
Who is invited for screening in the standard breast screening programme and how often
Between ages 50 to 71 Every 3 years
81
How often should a BRCA1 carrier be invited for screening and what imaging modality
Annual testing MRI
82
3 features of ovarian hyperstimulation syndrome
Severe bloating Nausea and vomiting SOB
83
Why do you get SOB in ovarian hyperstimulation
Hyperstimulated ovaries release vasoactive mediators Increased capillary permeability causes third spacing SOB due to pleural effusion
84
State the initial test of choice for gonorrhoea in men and the type of sample
First catch urine, NAAT
85
What follow up is required in gonorrhoea infection
Test of cure
86
What resistance pattern is against amoxicillin, co-amoxiclav, trimethoprim
Extended spectrum beta-lactamase producer
87
Additional imaging for pyelonephritis
Abdominal ultrasound
88
Medical management of missed miscarriage
Oral mifepristone (progesterone antagonist) 48 hours later, if POC haven't passed then misoprostol prostaglandin (vaginal, oral or sublingual) OFFER ANTI-EMETICS AND PAIN RELIEF
89
2 referral criteria for NVP
Unable to keep down liquids or oral antiemetics Continued N/V with ketonuria and weight loss >5%
90
Fluid prescribed for HG
Normal saline with added potassium
91
Triad of HG and score used to classify severity
5% pre-pregnancy weight loss Dehydration Electrolyte imbalance PUQE
92
Situations where medical management of miscarriage is preferred
Increased risk of haemorrhage e.g. late in 1st trimester, coagulopathies Previous traumatic experiences a/w pregnancy Evidence of infection
93
When should pregnancy test be performed after miscarriage
3 weeks
94
2 types of surgical management for miscarriage
Vacuum aspiration local anaesthetic Surgical management in theatre

SAQ for finals (20 decks)

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