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AKT > Gynaecology 2 > Flashcards

Gynaecology 2 Flashcards

1
Q

Contraception in menopausal women

A

> 50yo 12 months post last period
<50 24 months post last period

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2
Q

Average age of menopause
Average length of menopausal symptoms

A

51yo
7 years

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3
Q

Menopause Mx Classification (3)

A

Lifestyle
Hormonal
Non-hormonal

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4
Q

Lifestyle mx of menopause
Hot flushes (3)
Sleep disturbance (2)
Mood (3)
Cognitive symptoms (2)

A

Hot flushes
Regular exercise, weight loss and reduce stress

Sleep disturbance
Good sleep hygiene, avoid late evening exercise

Mood
Regular exercise, good sleep hygiene and relaxation

Cognitive symptoms
Regular exercise and good sleep hygiene

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5
Q

HRT CI (4)

A

Breast ca
Oestrogen sensitive ca
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia

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6
Q

HRT with a uterus, without

A

Combined PO or transdermal
Oestrogen only

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7
Q

Non HRT Mx of menopause
Vasomotor (3)
Vaginal dryness (2)
Psychological sx (3)
Urogenital sx (1)

A

Fluoxetine, citalopram, venlafaxine
Lubricant/ moisturiser
Self help, CBT, antidepressants
Vaginal oestrogen

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8
Q

How long should HRT be taken?

A

2-5 years

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9
Q

Menopause long term complications (2)

A

Osteoporosis
Increased risk of ischaemic heart disease

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10
Q

Menorrhagia can be caused by hyper or hypothyroidism?

A

Hypo

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11
Q

Menstrual cycle
Explain the cycle/ phases in a 28 day cycle
(Split into 4)

A

Days:
1-4 menstruation
5-13 follicular phase
14 ovulation
15-28 luteal phase

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12
Q

What happens to the basal body temperature during the menstrual cycle?

A

Falls prior to ovulation and rises following ovulation due to high prog

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13
Q

What happens during the follicular phase?
Endometrium
Ovary
Hormones
Mucus
Temperature

A

Endometrial proliferation
Increasing follicles with one becoming dominant
Increased FSH + oestradiol and LH surge leading to ovulation
Thick mucous, just prior to ovulation it becomes clear and stretchy
Falls prior to ovulation

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14
Q

What happens during the luteal phase?
Ovary
Hormones
Mucus
Temperature

A

Corpus luteum
Prog secreted by corpus luteum and rises
Oestrodial also increases
If corpus luteum degenerates then prog falls
Mucous thick and scant
Temp rises post ovulation

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15
Q

Ovarian ca RF (4)

A

FH
Early menarche
Late menopause
Nulliparity

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16
Q

Cervical ca RF

A

Increased number of sexual partners
High parity
HPV
Smoking
HIV

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17
Q

Endometrial ca RF

A

Nulliparity
Early menarche
Late menopause

Obesity
Unopposed oestrogen
DM
Tamoxifen
PCOS
Hereditary colorectal ca

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18
Q

Features of ovarian ca (6)

A

Abdominal distension
Bloating
AP/ pelvic pain
Urinary symptoms
Early satiety
Diarrhoea

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19
Q

Ovarian ca Ix (2)

A

Ca125
US

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20
Q

VIN what is it?

A

Vulval intraepithelial neoplasia
Pre cancerous lesion of the vulva

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21
Q

RF for VIN (4)

A

HPV 16 & 18
Smoking
Herpes simplex virus 2
Lichen planus

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22
Q

VIN features (2)
Describe the lesions

A

Itching
Burning
Raised, well defined skin lesions

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23
Q

RF for vulval ca (4)

A

VIN
HPV
Immunosuppression
Lichen sclerosus

23
Q

RF for vulval ca (4)

A

VIN
HPV
Immunosuppression
Lichen sclerosus

24
Q

Inguinal lymphadenopathy
Itching
Irritation
Lump/ ulcer on the majora
=

A

Vulval ca

25
Q

Offensive, thin, white/grey, fishy discharge

A

BV

26
Q

Offensive, yellow, green, frothy, strawberry cervix, vulvovaginitis

A

TV

27
Q

Mx candidiasis
1st line
2nd line
If there are vulval sx

A

Oral fluconazole 150mg
Clotrimazole pessary 500mg
Topical imidazole

28
Q

Definition of recurrent vaginal candidiasis
Ix (2)

A

4 or more episodes
HVS for MCS
HbA1c

29
Q

Mx recurrent candidiasis
Induction
Maintenance

A

Induction PO fluconazole every 3 days for 3 doses
Maintenance PO fluconazole weekly for 6 months

30
Q

What is the most common ovarian cyst?

A

Follicular cyst

31
Q

Most common benign ovarian tumour in women under 30yo

A

Dermoid cyst

32
Q

Cysts on premenopausal women mx

A

Conservative if:
especially if <35yo and <5cm and reported as simple

Repeat US 8-12 weeks

33
Q

Cysts on postmenopausal women mx

A

Refer to gynae

34
Q

Whirlpool sign on USS =

A

Ovarian torsion

35
Q

Ovulation induction for PCOS mx
First line
2nd line (medical) (2)

A
  1. Weight loss
  2. Letrozole, clomiphene
36
Q

What is letrozole? (MOA)

A

Aromatase inhibitor

37
Q

Clomiphene MOA

A

Oestrogen receptor modulator

38
Q

What treatment can be used in hypogonadotropic hypogonadal anovulation

A

Gonadotropin therapy

39
Q

OHSS features/ life-threatening complications (3)

A

Hypovalaemic shock
Acute renal failure
VTE

40
Q

Most common cause of PID (2)

A

N. gonorrhoeae
Mycoplasma genitalium

41
Q

Mx PID (2)

A

PO ofloxacin, metro
OR
IM cef, PO doxy, PO metro

42
Q

What is Fitzy Hugh Curtis Syndrome

A

Perihepatitis with PID/ post PID

43
Q

PID complications (4)

A

Fitz Hugh Curtis
Infertility
Chronic pelvic pain
Ectopic pregnancy

44
Q

What is mittelschmerz?

A

Pain the middle of menstrual cycle secondary to ovulation

45
Q

Mx of PMS
Mild
Mod
Severe

A

Mild lifestyle advice
Moderate COCP e.g Yasmin
Severe SSRI either continuous or just during day 15-28

46
Q

Baseline Ix for PCOS (7) bloods

A

FSH, LH, prolactin, TSH, testosterone, sex hormone binding globulin
Raised LH:FSH
Raised testosterone
Prolactin elevated
SHBG low
HbA1c/ impaired glucose tolerance

47
Q

What is the Rotterdam criteria for PCOS

A

2 out of 3 for diagnosis

Infrequent or no ovulation/ menstruation
Clinical or biochemical signs of hyperandrogenism
PCO seen on US >= 12 follicles measuring 2-9mm OR increase ovarian volume >10

48
Q

PCOS Mx
General (2)

A

Weight reduction
COCP

49
Q

PCOS mx
Infertility (4)

A

Infertility
Weight loss
Clomiphene
Metformin
Gonadotrophins

50
Q

PCOS hirsutism and acne (2)

A

COCP
Topical eflornithine

51
Q

Classification of urinary incontinence (5)
Explain/ examples

A

Overactive bladder/ urge - detrusor overactivity
Stress - coughing/ laughing
Mixed - urge and stress
Overflow e.g obstruction such as prostate enlargement
Functional e.g dementia, sedating meds etc

52
Q

Ix urinary incontinence (4)

A

Bladder diaries for 3/7
VE to r/o prolapse
Urine dipstick + culture
Urodynamic studies

53
Q

Mx urge (5)
Hint 4 are medication examples

A
  1. Bladder retraining - 6 weeks (gradually increase intervals between voids)

Antimuscarinics
2. Oxybutynin IR
3. Tolterodine
4. Darifenacin

Beta 3 agonist
5. Mirabegron

54
Q

Mx stress (3)

A
  1. Pelvic floor muscle training
    8 contractions performed 3 times per day for a minimum of 3 months
  2. Surgery (midurethral tape procedures)
  3. Duloxetine

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