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RHCN > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Causes of PID

A

Chlamydia
Gonorrhoea
Mycoplasma genitalium
Anaerobes

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2
Q

Equivalent of PID in men

A

epididymorchitis

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3
Q

Mirena coil and PID

A

is protective

thickens mucus so bugs can’t climb up

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4
Q

High dose progesterone

A

thickens endometrium

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5
Q

Low dose progesterone

A

thins endometrium

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6
Q

Early pregnancy hCG

A

doubles every 28 hours (66%)

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7
Q

where else can you get chlamydia?

A

any columnar cells

eyes, gut, cervix, throat, urethra

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8
Q

NAAT sensitivity

A

80-100%

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9
Q

NAAT specificity

A

93-100%

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10
Q

How many with chlamydia are asymptomatic?

A

70%

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11
Q

Gonorrhoea treatment

A

ceftriaxone 2g Once

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12
Q

Anaerobes treatment

A

Metronidazole
14 days
400mg BD

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13
Q

Fitz hugh curtis

A

liver adhesions

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14
Q

If you only have 1 tube:

A

fertility down by 15%

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15
Q

If you only have 1 ovary

A

fertility down by 25%

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16
Q

RF for endometrial cancer

A 
unapposed oestrogen
PCOS
Obesity
Late menopause
Ovarian thecal cell tumour
family history of breast
family history of colon (NHPCC)
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17
Q

How long is a cervix?

A

4-5cm

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18
Q

how thick should the endometrium ideally be?

A

<4mm

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19
Q

Cervical cancer stagin

A
  1. confined to cervix
  2. beyond cervix but not to pelvic wall or lowe 1/3 of vagina
  3. to pelvic wall or lowe 1/3 of vagina
  4. Invades bladder, rectum or METS
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20
Q

during puberty and pregnancy

A

the SCJ migrates down the os to the surface of the cervix. (ectopy)

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21
Q

The site where the columnar is undergoing metaplasia is called the:

A

transformation zone

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22
Q

Transformation zone

A

the area that cells under go metaplasia

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23
Q

SCJ

A

can move

migrates back up after puberty

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24
Q

Ectropian

A

can cause a lot of mucus
post coital bleeding
OCP can cause it

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25
Q

Metaplasia vs. dysplasia

A

metaplasia is normal

dysplasia is pre cancerous

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26
Q

HPV infects

A

squamous epithelium

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27
Q

Most dangerous type of HPV

A

16- 50% of cervical cancer

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28
Q

How many sexually active will get HPV?

A

70%

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29
Q

CIN 1

A

mild dysplasia (basal 1/3)

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30
Q

CIN 2

A

Moderate dysplasia (basal 2/3)

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31
Q

How many CIN 2 will regress in 2 years

A

50%

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32
Q

CIN 3

A

Severe dysplasia

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33
Q

Carinoma in situ (cervical)

A

CIN 3

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34
Q

Prognosis of cin3

A

18% cancer in 10 years

36% cancer in 20 years

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35
Q

Time between HPV infection and cervical cancer is

A

10-20 years

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36
Q

Recurrence of CIN?

A

20%

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37
Q

Rf for CIN

A 
Young sex
Multiple partners
immunosuppressant drugs/disease
HIV
smoking
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38
Q

Acetic acid in smears

A

turns areas of dyslasia white

the greater the intensity of the white, the greater the level of dyskaryosis

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39
Q

Iodine solution in smears

A

Iodine is taken up by glycogen
normal squamous epithelium will appear very dark brown
-dysplastic cells don’t take it up and appreak yellow/orange
(sensitive, not specific)

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40
Q

silver nitrate

A

after biopsy

encourages haemostasis and is bacteriostatic

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41
Q

CIN 1 treatment

A

usually nothing unless persits for years

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42
Q

CIN 2/3 treatment

A

LLETZ

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43
Q

LLETZ complications

A

may require a c-section in furture
increased PPROM
increase pre-terms

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44
Q

Cervical cancer RF

A 
SMOKING
number of partners
early first sex
lots of sex
HPV
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45
Q

Cervical cancer screening

A

25-65

every three years till 50 then every 5 years

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46
Q

borderline changes in endocervical cells

A

refer for colposcopy

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47
Q

borderline changes in squamous cells

A

repeat in 6 months
compare bast results
refer
need 3 in a row of normal ones before going back to normal scrrening

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48
Q

What type of cancer is cervical cancer?

A

80% Squamous cell

rest adenocarcinoma

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49
Q

symptoms of cervical cancer

A

post-coital bleeding
other bleeding
blood stained discharge
abnormal bleeding in pregnancy

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50
Q

staging of cervical cancer involves:

A

CXR
rectal exam
intravenous urogram
biopsy

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51
Q

cervical cancer staging survival

A

1-79%
2-47%
3-22%
4-7%

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52
Q

Cervical cancer 1b and up

A

may need a wider margin >5mm
Total hysterectomy
Radiotherapy (if can’t have surgery)

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53
Q

Most common type of endometrial cancer

A

adenocarcinoma

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54
Q

RF for endometrial cancer

A 
high oestrogen
no children
late menopause
PCOS
obesity
unapposed oestrogen
diabetes
family history of breast or colon cancer
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55
Q

Protective for endometrial cancer

A

COCP and pregnancy

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56
Q

endometrial cancer staging

A
  1. in body of uterus
  2. body of uterus + cervix
  3. outside uterus (in pelvis)
  4. outside pelvis
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57
Q

stage 1 endometrial cancer

A
  1. in body of uterus
    a. endometrium
    b. upper 1/2 myometrium
    c. lower 1/2 myometrium
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58
Q

to shrink endometrial tumour:

A

medroxyprogesterone acetate

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59
Q

endometrial cancer survival overall

A

75% 5 years

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60
Q

recurrence of endometrial cancer

A

at vaginal vault!

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61
Q

how does endometriosis get to the lung?!

A

lymph of blood spread

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62
Q

frozen pelvis

A

so many adhesions from endometriosis

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63
Q

what is endometriosis?

A

you got this…

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64
Q

Treatment of endometriosis

A

COCP
Progesterones
Intrauterine systems
GnRH analogues

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65
Q

Side effects of GnRH analogues

A

Menopause-like side effects of GnRH analogues include hot flushes, vaginal dryness and low libido.
HRT may be recommended in addition to GnRH analogues to prevent these side effects.

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66
Q

examples of GnRH analogues

A 
buserelin
goserelin
nafarelin
max 6 months 
temporary menopause
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67
Q

anti progesterone example

A

danazol
max 6 months
temporary menopause

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68
Q

dyschezia

A

endometriosis

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69
Q

tibolone

A

HRT
bone protection
oestrogen and progesterone

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70
Q

most common site for ectopic

A

ampulla

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71
Q

uterine artery comes off

A

internal iliac

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72
Q

lymph drainage of uterus

A

external iliac and aortic nodes

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73
Q

lymph drainage of cervix

A

internal iliac and sacral

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74
Q

lymph drainage of ovaries

A

para-aortic nodes

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75
Q

most important ligaments of the uterus

A

pubococcygeus

then coccygeus

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76
Q

GnRH release in first half of period

A

every 90 mins

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77
Q

FSH works where?

A

ovary

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78
Q

ovary makes what?

A

oestrogen and progesterone

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79
Q

LH works where?

A

ovary

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80
Q

How many cysts is abnormal?

A

more than 3

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81
Q

Most common type of urinary incontinence?

A

stress

then urgency

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82
Q

SUM CORF

A

Stress
urgency
mixed

Continuous
Overflow
Reflux
Functional

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83
Q

SNRI for incontinence

A

duloxetine

STRESS incontinence

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84
Q

Other treatments for incontinence

A 
vaginal wall repair in prolapse
colpo-suspension
mid-urethral tape
bulking ages (collagen, silicone, hyaluronic acid)
artificial sphincter
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85
Q

Overflow incontinence

A

post-op, diabetes, pelvic mass, epidural

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86
Q

Treatment for overflow incontinence

A

intermittent self catheterisation

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87
Q

Types of prolapse

A 
urethrocele
cystocele
rectocele
enterocele
uterine
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88
Q

Anterior vaginal wall repair for

A

cystocele

uretrocele

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89
Q

posterior vaginal wall repair for

A

rectocele

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90
Q

uterine prolapse treatment

A

hysterectomy

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91
Q

stages of uterine prolapse

A
  1. can see on examination
  2. poking out
  3. all the way out
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92
Q

how long does a period usually last?

A

4-7 days

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93
Q

how much blood loss in a period?

A

30ml

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94
Q

define oligomenorrhoea

A

> 35 days

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95
Q

define polymenorrhoea

A

<24 days

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96
Q

PALM COEIN

A

Polyps
Adenomyosis
Leiomyoma (fibroids)
Malignancy

Coagulopathy
Ovulatory
Endometrial
Iatrogenic
Not yet classified
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97
Q

How do fibroids cause heavy bleeding?

A

increase surface area

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98
Q

what reduces blood loss by 15-50%?

A

Transexamic acid

99
Q

Drugs to stop bleeding

A 
Transexamic acid
Mefanamic acid
Mirena coil
Ablation
Hysterectomy
100
Q

SSRI for menopause

A

clonidine

101
Q

average age of menopause

A

49-51

102
Q

Post menopausal bleeding is when it is??

A

12m after last period

103
Q

Benefits of HRT

A

decrease colorectal cancer

decrease fracture NOF

104
Q

Risks with HRT

A

increased CHD
increase Stroke
increase VTE

105
Q

delay in return of fertility with

A

injection

106
Q

how long does the implant work for?

A

3 years

107
Q

male condom failure rate

A

2-15%

108
Q

Breast cancer and contraception

A

copper coil only

109
Q

BRCA and migrane

A

should have COCP

110
Q

how long for accurate pregnancy test

A

3 weeks

111
Q

follicular phase

A

9-21 days

112
Q

luteal phase

A

12-14 days

113
Q

Ectropion

A

pregnancy
pill
puberty

114
Q

how many fibroids are symptomatic?

A

50%

115
Q

other name for fibroid

A

leiomyomata

116
Q

RF for fibroids

A

FH
Afro-carribean
Approaching menopause

117
Q

Fibroids grow in response to:

A

oestrogens and progesterones

118
Q

fibroids after menopause

A

generally stop growing and calcify

119
Q

Fibroid growth is:

A

cyclical

120
Q

fibroids that cause menorrhagia

A

submucosal

121
Q

Degeneration of fibroid

A

decreased blood supply

causes sepsis

122
Q

Sx of fibroids

A

dysuria
hydronephrosis
constipation
sciatica

123
Q

Complications of fibroids

A 
subfertility
pre term labour
malpresentation
obstruction
PPH
124
Q

How to diagnose what type of fibroid

A

MRI

ultrasound will just show one and give an idea

125
Q

bleeding from fibroid

A

GnRH agonist
only 6 months
(causes osteoporosis, increased CVS risk)

126
Q

subserosal

A

mass extends outside of uterus

127
Q

Treatment of fibroids

A

GnRH to shrink then:
myomyectomy if want kids
hysterectomy if not
(also uterine artery embolization)

128
Q

subfertility

A

have been trying for a year and can’t concieve

129
Q

with regular intercourse how many couples get pregnancy in 1 and 2 years?

A

85%

92%

130
Q

Subfertility usually due to?

A

Female

131
Q

how many subfertility due to man?

A

10-30%

132
Q

commonest cause of subfertility in woman

A

PCOS

133
Q

causes of subfertility in women

A

hypothalamic hypogonadism
high prolactin
premature ovarian failure
thryoid disease

134
Q

tests for subfertility

A

women: day 2-5 baseline FSH, LH, TSH, PRL and testosterone

Mid luteal progesterone

anti-mullerian hormone- if low suggests premature ovarian failure

135
Q

tubal patency checked by

A

hysterosalpinogram

136
Q

normal semen

A 
>2ml volume
>7.2 pH
>20million per ml
>40million per ejaculate
>50% motile (forward)
>30% normal
137
Q

clomifene

A

stimulates oculation

then inject hCG to mature oocyte and cause release.

138
Q

Ovarian hyperstimulation syndrome

A

vascular hyperpermeable

pleural effusion and ascites

139
Q

Metformin in inferitility?!

A

PCOS if unresponsive to clomifene

140
Q

Intrauterine insemination for:

A

for male related problems
unexplained problems
minimal to mild endometriosis
WOMEN NEED PATENT TUBES

141
Q

IVF for

A

23-39 years old.
identified cause of fertility problem
have been trying for 2 years
NEED OVARIES!

142
Q

IUI involves

A

injecting sperm into uterus

143
Q

IVF involves

A

getting an egg
adding some sperm
incubating for 2-3 days
then inject into uterus

144
Q

ICSI involves

A

injecting individual sperm into egg to bypass natural barriers

145
Q

what in pregnancy suppresses gnrh?

A

prolactin

146
Q

oestrogen role

A

maintain accessory glands and organs
bone and muscle
secondary sex characteristics

147
Q

inhibin

A

produced by follicles to inhibit production of FSH.

148
Q

Follicular cells grow to become

A

granulosa cells

149
Q

graffian follice

A

dominant follice
grows rapidly from day 6-14 and makes oestrogen
LH then stimulates it to split (one large cell and one polar body)

150
Q

follicle gets stuck where before fertilization

A

metaphase II or meiosis.

151
Q

empty follice

A

remains in ovary and becomes corpus luteum

152
Q

start of luteal phase?

A

when oocyte release from ovary into tube

153
Q

what produces progesterone?

A

corpus luteum

154
Q

beta hCG does what to corpus luteum?

A

stops it from dying so it continues to make progesterone

corpus luteum gravitidas

155
Q

blood loss in menses?

A

35-80ml

156
Q

inhibin

A

inhibits FSH

157
Q

decidua

A

endometrial cells

all nutrition for first 16 days

158
Q

oestrogen inhibits

A

FSH and LH

159
Q

anovulatory

A

LH surge not enough to cause ovulation

160
Q

secondary ammenorhoe

A

after 6 months

161
Q

too big to be normal cyst

A

> 5cm

162
Q

ovarian cyst symptoms

A 
dull ache
pressure
dyspareunia
cyclical pain (endometrioma)
acute if bleeding, torsion, rupture.
163
Q

most common type of ovarian cyst

A

follicular

164
Q

types of ovarian cyst

A

follicular (resolve in months)
haemorrhagic
luteum cyst
endometrioma (chocolate)

165
Q

functional cysts and the cocp

A

don’t expect them.

166
Q

bartholins duct cyst

A

can become infected- abscess.

167
Q

premenstrual syndrome

A 
breast pain
moodswings
bloating
irritable
loss of libido
168
Q

Nabothian cyst

A 
retention cyst
firm bump on cervix
harmless
squamous epithelium of ectovcervix grows over columnar epithelium of endocervix
traps mucus
169
Q

how many cervical polyps become cancer?

A

1%

170
Q

primarry amenorrhoea

A

lack of menstruation by 16

OR lack of menstruation by 14 with no 2o sex characteristics

171
Q

haematometra

A

blood in uterus after induced labour
imperforate hymen
cancer of cervix
after termination

172
Q

thyroid and periods

A

hyperthyriod- ammenorhoea

hypothyroid- menorrhagia and amenorrhoea

173
Q

transexamic acid is an

A

anti-fibrinolytic

174
Q

clause A

A

risk of life to woman

175
Q

clause B

A

physical or mental health of woman
grave permanent injury
any time

176
Q

clause C

A

before 24 weeks

injury of physical or mental health

177
Q

Clause D

A

before 24 weeks

risk to other children

178
Q

Clause E

A

Risk to baby- serious damage.

179
Q

surgical abortion over 13 weeks

A

dilatation and evacuation (rather than suction)

180
Q

threatened miscarriage

A

bleeding and pain

closed os

181
Q

complete miscarriage

A

bleeding and pain then eases
closed os
empty uterus but endometrium >15mm

182
Q

incomplete miscarriage

A

bleeding and pain
open os
strange scan

183
Q

inevitable miscarriage

A

pain and bleeding
open os
normal scan

184
Q

treatment for ectopic

A

wait for it to die (if hcg falling)
if small enough IM methotrexate
if big or rupturing- remove tube!

185
Q

recurrent miscarriage

A

> 3 in a row
FIRST TRIMESTER
same dad

186
Q

causes of recurrent miscarriage

A 
antiphospholipid syndrome
fetal chromosome abnormalitites
anaatomical abnormalities
fibroids
thrombopilia
187
Q

hyperemesis

A

promethazine/cyclizine
fluids
thiamine

188
Q

vulval cancer most common

A

squamous cell (90%)

189
Q

average age of menopause

A

52

190
Q

what causes menopause

A

ovarian failure leading to oestrogen deficiency

191
Q

Vulval cancer sx

A

noticeable lump
itchiness
pain passing uring
bleeding or blood mucus

192
Q

RF for vulva cancer

A 
lichen slerosis
OLD
smoking
HPV infection
VIN
193
Q

menopause time

A

12 months after

194
Q

peri menopause

A

beginning of it (irregular menopause etc) to 12 months after

195
Q

vasomotor symptoms

A

hot flushes, night sweats
usually last for 5 years
but can have till 70!

196
Q

climateric

A

from reproductive to non-reproductive state.

197
Q

psychological sx of menopause

A

depression
anxiety
irritability
lethargy

198
Q

most common type of ovarian cancer

A

epithelial

199
Q

types of ovarian cancer

A

epithelial
germ cell
stromal

200
Q

Rf for ovarian cancer

A 
lots of periods- lots of eggs
age
family history
HRT
endometriosis
201
Q

sx of ovarian cancer

A

bloating
feeling full
early satiety

202
Q

staging ovarian cancer

A
  1. single or both ovaries
  2. ovaries and pelvis
  3. outside of pelvis and other parts of abdomen/lymph nodes
  4. beyond abdomen
203
Q

which is the only STI going down in prevalence?

A

chlamydia

204
Q

how many people in the world with aids?

A

34 million

205
Q

prevalence in uk of HIV

A

1.5/1000

206
Q

Late stage HIV

A

CD4<350

207
Q

when can we catch HIV on a test?

A

3-4 weeks after infection

208
Q

how high does prevalence have to be for us to offer routine testing?

A

0.2%

209
Q

PEP

A

needle stick injuries

210
Q

PEPSE

A

up to 1 month after sex
started within 72 hours
available at all GU and casualties

211
Q

non gonorrhoes urethritis

A

chlamydia
mycoplasma genitalium
ureaplasma urealyticum

212
Q

discharge in men

A

gonorrhoea or NGU

213
Q

complications of NGU

A

chronic
sexually acquired reactive arthritis
reiters
epididymo-orchitis

214
Q

discharge in women

A 
normal
foreign body
allergy
COCP
Infection
215
Q

discharging infection in women;

A 
BV
Thrush
Trichomonas
Gonorrhoea
Chlamydia
Mycoplasma genitalium
Herpes
216
Q

BV

A

fishy

caused by absent lactobacilli- overgrowth of anaerobes

217
Q

BV treatment

A

5 days metronidazole 400mg PO BD

218
Q

Candida

A

itchy, white, sore, dyspareunia

219
Q

candida treatment

A

clotrimazole 500mg PER VAGINA for a week

220
Q

trichomonas

A

smelly
itchy
dysuria
mobile protazoa

221
Q

treatment trichomonas

A

metronidazole 400mg BP Po 5days

222
Q

chlamydia contact tracing- symptomatic

A

4 weeks

223
Q

chlamydia contact tracing- asymptomatic

A

6 months

224
Q

gonorrhoea in men

A

discharge
dysuria
itchy
rectal discharge/bleeding

225
Q

gonorrhoea in women

A

discharge
dysuria
pelvic pain
rectal discharge and bleeding

226
Q

gonorrhoea treatment

A

ceftriaxone IM 500mg (may use an anaesthetic)

227
Q

gonorrhoea contact tracing- symptomatic

A

2 weeks

228
Q

gonorrhoea contact tracing- asymptomatic

A

3months

229
Q

complications of gonorrhoea

A

urethral stricture
disseminated gonococcal infection
arthritis
tenosynovitis

230
Q

Gardasil

A

3 Im injections aged 12 girls

231
Q

genital ulcer causes

A

CHISEL and bechets and IBD and drugs and trauma

232
Q

CHISEL

A 
Chancroid
Herpes
Inguinale
Syphillis
Eruption (drugs)
Lymphogranuloma venereum (chlamydia)
233
Q

Herpes

A

prodrome
PAINFUL
vesicles, erosions, ulcers

234
Q

painful ulcers

A

herpes

chancroid

235
Q

HSV1- children

A

oro-labial herpes
50% of genital ulcers (MOST COMMON)
dont really reoccur

236
Q

HSV2-adults

A

reoccur alot

237
Q

treatment for herpes ulcers

A

salt water

aciclovir 200mg 5d (5 times a day!)

238
Q

syphillis

A

painLESS ulcers.
primary- 90 days
secondary-
early latent

late>2 years= late latent
tertiary- brain, heart, skin

239
Q

papule that becomes an ulcer is a

A

chancre

240
Q

the chancre becomes secondary when

A

it spreads by the blood to the soles of the feet and palms.

241
Q

treatment for syphillis

A

benzathine penicillin IM once

or 3x over 3 weeks if late presentation

242
Q

Chancroid

A

gram negative coccobacillus

painful ulcers and lymphadenopathy

243
Q

granuloma inguinale

A

Klebsiella
DONOVAN bodies in macrophages

papule–>granuloma–>ulcer

RHCN (4 decks)

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