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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
Metaplasia vs. dysplasia
metaplasia is normal | dysplasia is pre cancerous
26
HPV infects
squamous epithelium
27
Most dangerous type of HPV
16- 50% of cervical cancer
28
How many sexually active will get HPV?
70%
29
CIN 1
mild dysplasia (basal 1/3)
30
CIN 2
Moderate dysplasia (basal 2/3)
31
How many CIN 2 will regress in 2 years
50%
32
CIN 3
Severe dysplasia
33
Carinoma in situ (cervical)
CIN 3
34
Prognosis of cin3
18% cancer in 10 years | 36% cancer in 20 years
35
Time between HPV infection and cervical cancer is
10-20 years
36
Recurrence of CIN?
20%
37
Rf for CIN
``` Young sex Multiple partners immunosuppressant drugs/disease HIV smoking ```
38
Acetic acid in smears
turns areas of dyslasia white | the greater the intensity of the white, the greater the level of dyskaryosis
39
Iodine solution in smears
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)
40
silver nitrate
after biopsy | encourages haemostasis and is bacteriostatic
41
CIN 1 treatment
usually nothing unless persits for years
42
CIN 2/3 treatment
LLETZ
43
LLETZ complications
may require a c-section in furture increased PPROM increase pre-terms
44
Cervical cancer RF
``` SMOKING number of partners early first sex lots of sex HPV ```
45
Cervical cancer screening
25-65 | every three years till 50 then every 5 years
46
borderline changes in endocervical cells
refer for colposcopy
47
borderline changes in squamous cells
repeat in 6 months compare bast results refer need 3 in a row of normal ones before going back to normal scrrening
48
What type of cancer is cervical cancer?
80% Squamous cell | rest adenocarcinoma
49
symptoms of cervical cancer
post-coital bleeding other bleeding blood stained discharge abnormal bleeding in pregnancy
50
staging of cervical cancer involves:
CXR rectal exam intravenous urogram biopsy
51
cervical cancer staging survival
1-79% 2-47% 3-22% 4-7%
52
Cervical cancer 1b and up
may need a wider margin >5mm Total hysterectomy Radiotherapy (if can't have surgery)
53
Most common type of endometrial cancer
adenocarcinoma
54
RF for endometrial cancer
``` high oestrogen no children late menopause PCOS obesity unapposed oestrogen diabetes family history of breast or colon cancer ```
55
Protective for endometrial cancer
COCP and pregnancy
56
endometrial cancer staging
1. in body of uterus 2. body of uterus + cervix 3. outside uterus (in pelvis) 4. outside pelvis
57
stage 1 endometrial cancer
1. in body of uterus a. endometrium b. upper 1/2 myometrium c. lower 1/2 myometrium
58
to shrink endometrial tumour:
medroxyprogesterone acetate
59
endometrial cancer survival overall
75% 5 years
60
recurrence of endometrial cancer
at vaginal vault!
61
how does endometriosis get to the lung?!
lymph of blood spread
62
frozen pelvis
so many adhesions from endometriosis
63
what is endometriosis?
you got this...
64
Treatment of endometriosis
COCP Progesterones Intrauterine systems GnRH analogues
65
Side effects of GnRH analogues
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.
66
examples of GnRH analogues
``` buserelin goserelin nafarelin max 6 months temporary menopause ```
67
anti progesterone example
danazol max 6 months temporary menopause
68
dyschezia
endometriosis
69
tibolone
HRT bone protection oestrogen and progesterone
70
most common site for ectopic
ampulla
71
uterine artery comes off
internal iliac
72
lymph drainage of uterus
external iliac and aortic nodes
73
lymph drainage of cervix
internal iliac and sacral
74
lymph drainage of ovaries
para-aortic nodes
75
most important ligaments of the uterus
pubococcygeus | then coccygeus
76
GnRH release in first half of period
every 90 mins
77
FSH works where?
ovary
78
ovary makes what?
oestrogen and progesterone
79
LH works where?
ovary
80
How many cysts is abnormal?
more than 3
81
Most common type of urinary incontinence?
stress | then urgency
82
SUM CORF
Stress urgency mixed Continuous Overflow Reflux Functional
83
SNRI for incontinence
duloxetine | STRESS incontinence
84
Other treatments for incontinence
``` vaginal wall repair in prolapse colpo-suspension mid-urethral tape bulking ages (collagen, silicone, hyaluronic acid) artificial sphincter ```
85
Overflow incontinence
post-op, diabetes, pelvic mass, epidural
86
Treatment for overflow incontinence
intermittent self catheterisation
87
Types of prolapse
``` urethrocele cystocele rectocele enterocele uterine ```
88
Anterior vaginal wall repair for
cystocele | uretrocele
89
posterior vaginal wall repair for
rectocele
90
uterine prolapse treatment
hysterectomy
91
stages of uterine prolapse
1. can see on examination 2. poking out 3. all the way out
92
how long does a period usually last?
4-7 days
93
how much blood loss in a period?
30ml
94
define oligomenorrhoea
>35 days
95
define polymenorrhoea
<24 days
96
PALM COEIN
Polyps Adenomyosis Leiomyoma (fibroids) Malignancy ``` Coagulopathy Ovulatory Endometrial Iatrogenic Not yet classified ```
97
How do fibroids cause heavy bleeding?
increase surface area
98
what reduces blood loss by 15-50%?
Transexamic acid
99
Drugs to stop bleeding
``` Transexamic acid Mefanamic acid Mirena coil Ablation Hysterectomy ```
100
SSRI for menopause
clonidine
101
average age of menopause
49-51
102
Post menopausal bleeding is when it is??
12m after last period
103
Benefits of HRT
decrease colorectal cancer | decrease fracture NOF
104
Risks with HRT
increased CHD increase Stroke increase VTE
105
delay in return of fertility with
injection
106
how long does the implant work for?
3 years
107
male condom failure rate
2-15%
108
Breast cancer and contraception
copper coil only
109
BRCA and migrane
should have COCP
110
how long for accurate pregnancy test
3 weeks
111
follicular phase
9-21 days
112
luteal phase
12-14 days
113
Ectropion
pregnancy pill puberty
114
how many fibroids are symptomatic?
50%
115
other name for fibroid
leiomyomata
116
RF for fibroids
FH Afro-carribean Approaching menopause
117
Fibroids grow in response to:
oestrogens and progesterones
118
fibroids after menopause
generally stop growing and calcify
119
Fibroid growth is:
cyclical
120
fibroids that cause menorrhagia
submucosal
121
Degeneration of fibroid
decreased blood supply | causes sepsis
122
Sx of fibroids
dysuria hydronephrosis constipation sciatica
123
Complications of fibroids
``` subfertility pre term labour malpresentation obstruction PPH ```
124
How to diagnose what type of fibroid
MRI | ultrasound will just show one and give an idea
125
bleeding from fibroid
GnRH agonist only 6 months (causes osteoporosis, increased CVS risk)
126
subserosal
mass extends outside of uterus
127
Treatment of fibroids
GnRH to shrink then: myomyectomy if want kids hysterectomy if not (also uterine artery embolization)
128
subfertility
have been trying for a year and can't concieve
129
with regular intercourse how many couples get pregnancy in 1 and 2 years?
85% | 92%
130
Subfertility usually due to?
Female
131
how many subfertility due to man?
10-30%
132
commonest cause of subfertility in woman
PCOS
133
causes of subfertility in women
hypothalamic hypogonadism high prolactin premature ovarian failure thryoid disease
134
tests for subfertility
women: day 2-5 baseline FSH, LH, TSH, PRL and testosterone Mid luteal progesterone anti-mullerian hormone- if low suggests premature ovarian failure
135
tubal patency checked by
hysterosalpinogram
136
normal semen
``` >2ml volume >7.2 pH >20million per ml >40million per ejaculate >50% motile (forward) >30% normal ```
137
clomifene
stimulates oculation | then inject hCG to mature oocyte and cause release.
138
Ovarian hyperstimulation syndrome
vascular hyperpermeable | pleural effusion and ascites
139
Metformin in inferitility?!
PCOS if unresponsive to clomifene
140
Intrauterine insemination for:
for male related problems unexplained problems minimal to mild endometriosis WOMEN NEED PATENT TUBES
141
IVF for
23-39 years old. identified cause of fertility problem have been trying for 2 years NEED OVARIES!
142
IUI involves
injecting sperm into uterus
143
IVF involves
getting an egg adding some sperm incubating for 2-3 days then inject into uterus
144
ICSI involves
injecting individual sperm into egg to bypass natural barriers
145
what in pregnancy suppresses gnrh?
prolactin
146
oestrogen role
maintain accessory glands and organs bone and muscle secondary sex characteristics
147
inhibin
produced by follicles to inhibit production of FSH.
148
Follicular cells grow to become
granulosa cells
149
graffian follice
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
follicle gets stuck where before fertilization
metaphase II or meiosis.
151
empty follice
remains in ovary and becomes corpus luteum
152
start of luteal phase?
when oocyte release from ovary into tube
153
what produces progesterone?
corpus luteum
154
beta hCG does what to corpus luteum?
stops it from dying so it continues to make progesterone | corpus luteum gravitidas
155
blood loss in menses?
35-80ml
156
inhibin
inhibits FSH
157
decidua
endometrial cells | all nutrition for first 16 days
158
oestrogen inhibits
FSH and LH
159
anovulatory
LH surge not enough to cause ovulation
160
secondary ammenorhoe
after 6 months
161
too big to be normal cyst
>5cm
162
ovarian cyst symptoms
``` dull ache pressure dyspareunia cyclical pain (endometrioma) acute if bleeding, torsion, rupture. ```
163
most common type of ovarian cyst
follicular
164
types of ovarian cyst
follicular (resolve in months) haemorrhagic luteum cyst endometrioma (chocolate)
165
functional cysts and the cocp
don't expect them.
166
bartholins duct cyst
can become infected- abscess.
167
premenstrual syndrome
``` breast pain moodswings bloating irritable loss of libido ```
168
Nabothian cyst
``` retention cyst firm bump on cervix harmless squamous epithelium of ectovcervix grows over columnar epithelium of endocervix traps mucus ```
169
how many cervical polyps become cancer?
1%
170
primarry amenorrhoea
lack of menstruation by 16 | OR lack of menstruation by 14 with no 2o sex characteristics
171
haematometra
blood in uterus after induced labour imperforate hymen cancer of cervix after termination
172
thyroid and periods
hyperthyriod- ammenorhoea | hypothyroid- menorrhagia and amenorrhoea
173
transexamic acid is an
anti-fibrinolytic
174
clause A
risk of life to woman
175
clause B
physical or mental health of woman grave permanent injury any time
176
clause C
before 24 weeks | injury of physical or mental health
177
Clause D
before 24 weeks | risk to other children
178
Clause E
Risk to baby- serious damage.
179
surgical abortion over 13 weeks
dilatation and evacuation (rather than suction)
180
threatened miscarriage
bleeding and pain | closed os
181
complete miscarriage
bleeding and pain then eases closed os empty uterus but endometrium >15mm
182
incomplete miscarriage
bleeding and pain open os strange scan
183
inevitable miscarriage
pain and bleeding open os normal scan
184
treatment for ectopic
wait for it to die (if hcg falling) if small enough IM methotrexate if big or rupturing- remove tube!
185
recurrent miscarriage
>3 in a row FIRST TRIMESTER same dad
186
causes of recurrent miscarriage
``` antiphospholipid syndrome fetal chromosome abnormalitites anaatomical abnormalities fibroids thrombopilia ```
187
hyperemesis
promethazine/cyclizine fluids thiamine
188
vulval cancer most common
squamous cell (90%)
189
average age of menopause
52
190
what causes menopause
ovarian failure leading to oestrogen deficiency
191
Vulval cancer sx
noticeable lump itchiness pain passing uring bleeding or blood mucus
192
RF for vulva cancer
``` lichen slerosis OLD smoking HPV infection VIN ```
193
menopause time
12 months after
194
peri menopause
beginning of it (irregular menopause etc) to 12 months after
195
vasomotor symptoms
hot flushes, night sweats usually last for 5 years but can have till 70!
196
climateric
from reproductive to non-reproductive state.
197
psychological sx of menopause
depression anxiety irritability lethargy
198
most common type of ovarian cancer
epithelial
199
types of ovarian cancer
epithelial germ cell stromal
200
Rf for ovarian cancer
``` lots of periods- lots of eggs age family history HRT endometriosis ```
201
sx of ovarian cancer
bloating feeling full early satiety
202
staging ovarian cancer
1. single or both ovaries 2. ovaries and pelvis 3. outside of pelvis and other parts of abdomen/lymph nodes 4. beyond abdomen
203
which is the only STI going down in prevalence?
chlamydia
204
how many people in the world with aids?
34 million
205
prevalence in uk of HIV
1.5/1000
206
Late stage HIV
CD4<350
207
when can we catch HIV on a test?
3-4 weeks after infection
208
how high does prevalence have to be for us to offer routine testing?
0.2%
209
PEP
needle stick injuries
210
PEPSE
up to 1 month after sex started within 72 hours available at all GU and casualties
211
non gonorrhoes urethritis
chlamydia mycoplasma genitalium ureaplasma urealyticum
212
discharge in men
gonorrhoea or NGU
213
complications of NGU
chronic sexually acquired reactive arthritis reiters epididymo-orchitis
214
discharge in women
``` normal foreign body allergy COCP Infection ```
215
discharging infection in women;
``` BV Thrush Trichomonas Gonorrhoea Chlamydia Mycoplasma genitalium Herpes ```
216
BV
fishy | caused by absent lactobacilli- overgrowth of anaerobes
217
BV treatment
5 days metronidazole 400mg PO BD
218
Candida
itchy, white, sore, dyspareunia
219
candida treatment
clotrimazole 500mg PER VAGINA for a week
220
trichomonas
smelly itchy dysuria mobile protazoa
221
treatment trichomonas
metronidazole 400mg BP Po 5days
222
chlamydia contact tracing- symptomatic
4 weeks
223
chlamydia contact tracing- asymptomatic
6 months
224
gonorrhoea in men
discharge dysuria itchy rectal discharge/bleeding
225
gonorrhoea in women
discharge dysuria pelvic pain rectal discharge and bleeding
226
gonorrhoea treatment
ceftriaxone IM 500mg (may use an anaesthetic)
227
gonorrhoea contact tracing- symptomatic
2 weeks
228
gonorrhoea contact tracing- asymptomatic
3months
229
complications of gonorrhoea
urethral stricture disseminated gonococcal infection arthritis tenosynovitis
230
Gardasil
3 Im injections aged 12 girls
231
genital ulcer causes
CHISEL and bechets and IBD and drugs and trauma
232
CHISEL
``` Chancroid Herpes Inguinale Syphillis Eruption (drugs) Lymphogranuloma venereum (chlamydia) ```
233
Herpes
prodrome PAINFUL vesicles, erosions, ulcers
234
painful ulcers
herpes | chancroid
235
HSV1- children
oro-labial herpes 50% of genital ulcers (MOST COMMON) dont really reoccur
236
HSV2-adults
reoccur alot
237
treatment for herpes ulcers
salt water | aciclovir 200mg 5d (5 times a day!)
238
syphillis
painLESS ulcers. primary- 90 days secondary- early latent late>2 years= late latent tertiary- brain, heart, skin
239
papule that becomes an ulcer is a
chancre
240
the chancre becomes secondary when
it spreads by the blood to the soles of the feet and palms.
241
treatment for syphillis
benzathine penicillin IM once | or 3x over 3 weeks if late presentation
242
Chancroid
gram negative coccobacillus | painful ulcers and lymphadenopathy
243
granuloma inguinale
Klebsiella DONOVAN bodies in macrophages papule-->granuloma-->ulcer

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