Gynaecology Flashcards
When is premature menopause?
Menopause before 40 weeks
What effect does the copper IUD have?
Spermicidal
What is primary amenorrhoea ?
Absence of menses by age 16
or absence of secondary sexual characteristic by 14
What is the treatment of primary dysmenorrhea?
NSAID (Prostaglandin inhibitor)
OCP
Progestin IUD
What is found on history of endometriosis?
Cyclical pelvic pain
Pain during sex
What is found on history/exam of adenomyosis?
Menorrhagia
Enlarged uterus
Boggy uterus
What is the treatment of endometriosis ?
OCP FIRST LINE
What is the treatment of adenomyosis ?
NSAID first line
plus OCP or progestins
When should endometrial biopsy be performed?
Endometrial thickness > 4mm in postmenopausal woman
How is acute heavy bleeding managed?
High dose estrogen IV stabalise endometrium
Transition to OCP or add progestin when bleeding stalalised
What is the deficiency in congenital adrenal hyperplasia?
21 hydroxylaze deficiency
PCOS criteria?
- Polycystic ovaries
- Oligo-and/or an ovulation
- Hyperandrogenism
What is the presentation of PCOS?
Obesity menstrual cycle disruption Infertility Acne Hirstutusm Acanthosis nigricans Metabolic syndrome
How to test for hyperandrogegism in PCOS?
Raised testosterone (free better than total)
What is the treatment of PCOS in a woman not wanting to have bb’s?
OCP + metformin
What is the treatment of PCOS in a woman wanting to have bb’s?
Clomiphene + metformin
What is the treatment of bartholin cyst?
warm soaks
What is the treatment of bartholin abscess
Aspiration and incision
Treatment of BV?
Metronidazol or vaginal clyndamycin
What is the treatment of PID?
Outpatient
- ceftriaxone IM 1 dose
- Doxycycline X 14 days
- +/- metronidazole X 14 daya
Presentation of Toxic Shock Syndrome?
Fever Vomit Watery diarrhoea Desquamation at the palms and soles Macular rash
How is TSS diagnosed?
Clinical presentation:
- Fever > 38.9
- Hypotension
- Skin findings
Treatment of TSS?
Rapid rehydration
Empiric abx: clindamycin + vancomycin
Treatment of an asymptomatic fibroid?
Expectant management with annual pelvic exam
What is the pharmacological management of fibroids?
OCP
Medroxyprogesterone or danazol to slow down the bleeding
What is the surgical management of fibroids?
Woman who wants to have bb’s:
- Abdominal or hysteroscopic myomectomy
What is the commonest type of endometrial cancer?
Type I atypical endometrial hyperplasia
What is the presentation of endometrial cancer?
Bleeding
Pain
Metabolic syndrome
What is the most prevalent strains of HPV that cause cancer?
16 - SCC
18 - adenocarcinoma
What does gardasil protect against?
16, 18
6, 11 (warts)`
Recommended age for pap smear?
21- 65 every 3 years
What is the management of a woman who’s pap smear comes back as ASCUS
> 30 yo
- HPV DNA testing
If positive: colposcopy
If negative: repeat cytology in 12 mo
< 30 yo
- repeat cytology in 6 mo
If Positive: colposcopy
If negative: repeat cytology in 6 mo and if -ve can go back to 3 yearly
What is the management of a woman who’s pap smear comes back as ASC - H
Colposcopy
What is the management of a woman who’s pap smear comes back as atypical glandular cells of undetermined significance (AGUS)
Colposcopy +/- sampling
What are the RF for vulvar cancer?
HPV 16, 18, 31
Lichen sclerosis
Diabetes, obesity, HTN CVD…
What are key words that describe lichen sclerosis?
Atrophic
Paper-like skin
What is precocious puberty?
2ndary sexual characteristics before the age of 8
How to investigate precocious puberty?
Bone age
GnRH stimulation test
Treatment of central precocious puberty?
leuprolide
Where does breast cancer spread?
Bone
Liver
Thyroid
Prostate
Which adjuvant treatment should ER/PR+ve breast cancer women get?
Tamoxifen
or aromatase inhibitor in postmenopausal women
Which adjuvant treatment should HER2+ve breast cancer women get?
trastuzumab
