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O&G - C.U > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

2 systemic disorders causing Menorrhagia

A

Hypothyroidism

Clotting disorders

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2
Q

Local pathology causing menorrhagia

A 
Fibroids 
Polyps 
Endometrial carcinoma 
Endometriosis 
Pelvic inflammatory disease 
Dysfunctional uterine bleeding (diagnosis of exclusion)
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3
Q

Iatrogenic cause of menorrhagia

A

Copper IUD

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4
Q

Important red flag questions in menorrhagia

A

Intermenstrual bleeding

Post coital bleeding

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5
Q

How to subjectively assess abnormal uterine bleeding?

A 
clots 
noctural soiling 
flooding
wearing double sanitary protection 
interfear with work / social events
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6
Q

With AUB what condition to check they’re not suffering from as a result?

A

Anaemia - lethargy / breathlessness

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7
Q

Premenstrual dysmenorrhoea indicates?

A

endometriosis

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8
Q

How does PID present?

A

Fever
Pelvic pain
Dyspareunia
Vaginal discharge

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9
Q

What in the PMH could cause AUB?

A

PCOS
Thyroid disease
Clotting disorders
Contraceptive hx

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10
Q

What test should be performed in AUB in all women 45+

A

endometrial biospy

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11
Q

Two types of medical treatment for menorrhagia

A

Antifibrinolytics / haemostatics

Hormone therapy

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12
Q

Antifibrinolytic used in menorrhagia

A

Tranexamic acid

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13
Q

What is the risk with tranexamic acid?

A

Thrombosis

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14
Q

Other non hormone therapy used in menorrhagia

A

NSAIDS

Aspirin - prostaglandin inhibitor

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15
Q

What hormonal therapy is most useful for anovulatory menorrhagia?

A

Progestrogens

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16
Q

Hormonal therapies for menorrhagia

A

Porgestogens
IUS
COCP

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17
Q

Surgical treatments for menorrhagia

A

Hysterscopic ressection of interuterine pathology e.g. fibroids / endometrial polyps
Open myomectomy - fibroids
Endometrial ablation
Hysterectomy

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18
Q

Who is endometrial ablation not appropriate for?

A

women wishing to conceive

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19
Q

Complications of endometrial ablation

A

Uterine perforations
Fluid overload - non electrolyte sol. used in electrosurgery
Haemorrhage
Infection

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20
Q

Uterine fibroids are

A

benign tumour of the myometrium

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21
Q

What situation can cause fibroids to

  • grow
  • shrink
A
  • pregnancy - hyperoestrogenic state

- menopause - hypo-oestrogenic state

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22
Q

what 3 things cause pain in women with fibroids?

A

degeneration of fibrois
associated pelvic varicosities
stretching of uterine ligaments

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23
Q

How can fibroids cause subfertility?

A

press on the cornual region of the fallopian tube

submucosal fibroids are hormonally active - may affect implantation and cause miscarriage

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24
Q

where may fibroids put pressure on

A

bladder - urinary symptoms

rectum - abdo bloating

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25
Q

4 types of fibroid

A

submucous
intramural
subserous
pedunculated

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26
Q

Risk factors for fibroids

A

Afro-caribbean women
Increasing age
Nulligravidity
Obesity

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27
Q

Protective factors from fibroids?

A

Smoking
Use of COCP
Full term pregnancy

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28
Q

Gynaecological complications of fibroids?

A

Degeneration
Torsion if pedunculated
Malignancy - v small risk of leimyosarcoma

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29
Q

How can fibroids effect pregnancy?

A

Infertility
Obstructed labour
Risk of PPH

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30
Q

First line imaging investigation for fibroids?

A

USS

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31
Q

Gold standard imaging for fibroids?

A

MR

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32
Q

3 indications for treating fibroids?

A

Symptomatic
Rapidly enlarging
Cause infertility

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33
Q

Adjunct to surgery for fibroids?

A

GnRH analogues - reversible, temporary, chemical menopause

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34
Q

Surgical options for fibroids

A

Transcervical resection - hysteroscopy - submucous fibroids
Myomectomy - open / closed
Hysterectomy

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35
Q

New treatment option for fibroids?

A

Uterine artery embolism

  • less invasive than surgery
  • radiological embolisation of fibroids
  • catheter inserted into femoral artery
  • inject microbeads into arteries supplying fibroids (thrombosis and fibroid infarction)
  • complications - infection, pain, failed treatment, does not preserve fertility
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36
Q

4 important aspects of an early pregnancy complication hx?

A

LMP
Last cervical smear
Bleeding / discharge
Pain

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37
Q

Risk factors for ectopic pregnancy?

A 
PID 
Tubal surgery 
Peritonitis / pelvic surgery 
Endometriosis 
IUCD in situ 
IVF pregnancy
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38
Q

What is cervical shock?

How does it present?

A

vagal response to dilation caused by products of conception distending the cervical canal

Pulse and BP would both be low

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39
Q

Signs of haemorrhage due to ectopic

A

Pulse weak and tachycardic
Reduced BP
Pt pale, sweaty, unwell and may collapse

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40
Q

Miscarriage abdo exam

A

Abdo soft and >12 weeks then uterus may be palpable

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41
Q

Ectopic pregnancy abdo exam

A

Uterus not palpable
Tenderness on the affected side
May be some guarding and rebound tenderness

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42
Q

ruptured ectopic pregnancy abdo exam

A

Entire abdomen tense, tender with guarding and rebound tenderness

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43
Q

What is an ectropian?

A

Columnar epithelium present in the vaginal portion of the cervix
Not pathological
Bleeds easily
Common in pregnancy due to oestrogen changes
Bleeds more if irritated e.g. due to infection
take swabs and treat infection

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44
Q

Threatened miscarriage =

A

bleeding occurring before 24 weeks

cervix closed on examination

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45
Q

Inevitable miscarriage =

A

bleeding before 24 weeks

cervix is OPEN on examination

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46
Q

Missed / delayed / silent miscarriage =

A

scan shows no viable fetus / empty intrauterine sac
Cervix closed on exam
Patient may not have any bleeding

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47
Q

Complete miscarriage =

A

no products of conception on scan
patient has had bleeding
cervix closed on exam

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48
Q

Incomplete miscarriage =

A

scan shows products of conception left in the uterus
patient has had bleeding
cervix is open on exam

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49
Q

Contributing factors to miscarriage

A 
Fetal abnormality 
Infection 
Maternal age 
Abnormal uterine cavity 
Maternal illness 
Intervention e.g. amniocentesis and CVS
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50
Q

Surgical management of miscarriage -

A

Evacuation of retained products of conception

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51
Q

Complication of ERPC

A

Endometritis

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52
Q

Endometritis presentation =

A

fever, malaise, lower abdo pain, change in vaginal bleeding

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53
Q

Up to what week can watch and wait management be given for miscarriage

A

13

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54
Q 
If it's not clear whether a patient had an ectopic pregnancy what test should be done? 
What results would be expected
- viable pregnancy 
- miscarriage 
- ectopic
A

Beta HCG test 48hrs apart

  • doubled
  • significantly reduced
  • increased or stayed the same but not doubled
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55
Q

Two surgical options for ectopic pregnancy

A

Salpingectomy - especially if ruptured

Salpingotomy

56
Q

Medical treatment for tubal ectopic

A

Methotrexate, IM 50mg/m2

57
Q

What needs to be discussed with the mother who has an ectopic pregnancy ?

A

respectful disposal of fetal tissue

58
Q

Criteria for expectant management of ectopic preg

A

minimal symptoms
patient stable
low / falling hCG
Mass <4cm on USS

59
Q

Criteria for medical management ectopic preg

A

static / rising hCG

No contraindications to methotrexate

60
Q

Advice about methotrexate

A

can’t get pregnant for 3m after

61
Q

criteria for surgical management of ectopic pregnancy

A 
patient clinically unstable 
hCG <5000 
US mass >4cm 
failed medical treatment 
previous IVF/ ectopic
62
Q

STI causes of vaginal discharge

A

Chlamydia
Trichomas vaginalis
Neisseria gonorrhoea

63
Q

Non STI causes of vaginal discharge

A

Candida albicans

Bacterial vaginosis

64
Q

inflammatory causes of vaginal discharge

A

atrophic changes
allergic reaction
post op granulation tissue

65
Q

Malignant causes of vaginal discharge

A

Vulval carcinoma
Cervical carcinoma
Uterine carcinoma

66
Q

Other causes of vaginal discharge

A

Foreign body

Fistula

67
Q

Investigations if suspect infectious cause of vaginal discharge

A

microbiology swabs
MSU
Laprascopy - PID

68
Q

Suspect malignant cause of vaginal discharge - investigations to carry out..

A 
vulval biopsy 
cervical smear / biopsy 
pelvic uss 
endometrial sampling 
hysteroscopy
69
Q

Endometriosis =

A

growth of endometrial tissue outside of the uterine cavity

70
Q

clinical features of endometriosis

A

chronic pelvic pain
dysmenorrhoea
Deep dyspareunia
Subfertility

71
Q

gold standard investigation for endometriosis

A

laparascopy

72
Q

Medical management of endometriosis

What does it not achieve

A 
NSAIDs
Progestrogens 
COOP 
GnRH analouges 
Mirena coil

They do not improve subfertility

73
Q

surgical options for endometriosis

A

Laporoscopic excision

Laser treatment of endometriotic ovarina cysts

74
Q

When can a diagnosis of menopause be made
Women >50 y/o
Woemn < 50 y/o

A

12 m after LMP

24m after LMP

75
Q

Contraindications to HRT

A 
Undiagnosed PV bleeding 
Pregnancy 
Oestrogen dependent cancer 
Acute liver disease
Uncontrolled HTN

History of breast cancer
VTE
Recent stroke / MI / angina

76
Q

Long term benefits of HRT

A

reduced osteoporosis

reduce risk of coronary artery disease

77
Q

Risks of HRT

A 
VTN
Stroke
ovarian cancer if used 5+ yrs 
breast cancer
endometrial cancer
78
Q

Bacterial vaginosis treatment

A

oral metronidazole 5-7 days

79
Q

Presentation of trichomonas vaginalis

A

frothy yellow / green discharge
offensive
vulvovaginitis
strawberry cervix

80
Q

treatment for trichomonas vaginalis

A

metronidazole

81
Q

presentation of candida infection

A 
cottage cheese discharge 
vulvitis 
burning with urination 
pain with sex
redness round the vagina
82
Q

Risk factors for cervical cancer

A 
HPV infection 
Early age of first intercourse
high number of sexual partners 
lower socioeconomic group 
smoking
partner with protatic / penile cancer
83
Q

Symptomatic presentations of cervical cancer

A

intermenstrual bleeding
post coital bleeding
persistant vaginal discharge
post menopausal bleeding

84
Q

Management of cervical smear with borderline changes / low grade dyskaryosis

A

Reflext HPV test

+ve - refer for colposcopy in 6 weeks
-ve - return to routine screening

85
Q

High grade dyskaryosis / suspected cancer management t

A

refer to colposcopy within 2 weeks

86
Q

treatment of cervical intraepithelial neoplasia

A

large loop excision
needle excision
core biopsy

87
Q

ovarian hyperstimulation syndrome pathology

A

high oestrogen levels
vascular permeability
build up of fluid in the 3rd space
leads to intravascular fluid depletion

88
Q

ovarian hyperstimulation syndrome severe presentation

A

N&V
Painful abdominal distension
fluid shift - ascites and pleural effusions

89
Q

Risks with ovarian hyperstimulation syndrome

A

Hepatorenal failure
ARDS
increased risk of VTE

90
Q

What is associated with PCOS

A

insulin resistance
metabolic syndrome
increased risk of T2D

91
Q

Common features of PCOS

A 
Hirsutism
Acne 
Irregular / infrequent periods
Weight gain 
Infertility
Scalp hair loss
92
Q

What can be found on examination with PCOS

A

Hirsutism
Sweating / oily skin
Acne
Acanthosis nigricans

93
Q

Risk factors for endometrial cancer

A

Obesity
Tamoxifen
Early menarche / late menopause
Lynch syndrome

94
Q

Most common feature of endometrial cancer presentation?

A

post menopausal bleeding

95
Q

Ovarian cancer presentation

A 
bloating 
abdo pain 
early satiety 
loss of appetite 
(>12 times in a month)
96
Q

Main blood test in ovarian cancer?

A

Ca125

97
Q

Imaging in ovarian cancer?

A

USS firstly

then MR/CT to stage

98
Q

US - “snowstorm” description likely to be?

A

molar preg

99
Q

How may vulval and vaginal carcinomas present?

A

itching / bleeding

lesions on that area

100
Q

What drug is a risk factor for endometrial hyperplasia

A

tamoxifen

101
Q

Most common cause of PID

A

Chlamydia

102
Q

4 parts of a gynae history

A

Periods

Urology

Sexual hx

103
Q

Questions about periods

A 
Length
Regular  
How much ? heavy 
Pain - when 
Bleed after sex 
Intermenstrual bleeding 
Smear hx
104
Q

Urology questions in gynae

A

UTIs

Incontinence

105
Q

Obstetric hx

A 
How many children 
Types of deliveries
Traumatic deliveries  
HTN
Diabetes 
Terminations 
Miscarriages 
Ectopics
106
Q

Sexual

A 
CONTRACEPTION 
Pain 
Bleeding 
How many partners 
Any STIs
107
Q

Medical hx in gynae

A

Clotting
Thyroid
PCOS

108
Q

Red flag for endometrial cancer

A

Post menopausal bleeding

109
Q

Cervical cancer red flag

A

Looks abnormal

110
Q

1st line for menorrhagia

A

progesterone coil

111
Q

HRT if no oestrogen

A

continuous oestrogen-only therapy is given

112
Q

HRT if <1 yr since LMP and uterus

A

cyclical combined HRTW

113
Q

When is continuous HRT used?

A

taken cyclical combined for at least 1 year or

it has been at least 1 year since their LMP or

it has been at least 2 years since their LMP, if they had premature menopause (menopause below the age of 40)

114
Q

Menopause definition

A

Absence of menses for 12 months

115
Q

Menopause symptoms

A 
Amenorrhoea / irregular cycles 
Hot flushes 
Night sweats 
Vaginal symptoms 
Mood changes 
Sleep disturbance
116
Q

Tests when suspect menopause

A

Pregnancy test
FSH
Serum estradiol

117
Q

Initial treatment of menopause

A

Lifestyle changes

  • loose weight
  • exercise more
  • avoid caffeine / alcohol
118
Q

Treatment of menopause symptoms in women with uterus

Amenorrhoea >12 m

A

Continuous combined regimen - oestrogen & progestin

oral / patch

119
Q

In women with high thrombotic risk, which type of oestrogen is preferred to treat menopause?

A

Transdermal

120
Q

1st line Treatment of menopause symptoms in women without a uterus / progesterone coil inserted in last 5 years

A

Oestrogen alone

121
Q

Treatment of menopause symptoms in women with uterus with menstural irregularity and periods of irregularity

A

Sequential regimen

122
Q

2nd line Treatment of menopause symptoms in women without a uterus / progesterone coil inserted in last 5 years

A

SSRI

123
Q

Treatment of reduced libido

A

Oestrogen and androgen combined

124
Q

Treatment for urogenital atrophy only

A

Vaginal oestrogen +/- vaginal moisturiser

125
Q

Classification of dysmenorrhoea

A

Primary - absence of pelvic pathology

Secondary

126
Q

Common causes of secondary dysmenorrhoea

A

Endometriosis
Chronic PID
Fibroids
Polyps

127
Q

When does primary dysmenorrhoea usually start

A

6-12m after onset

128
Q

Investigations in dysmenorrhoea

A

Preg test
Swabs
Clotting, FBC, CRP
Ultrasound (usually TV)

129
Q

Menorrhagia definition

A

excess volume and or duration of menstrual bleeding

130
Q

People with which condition need annual cervical smear screening?

A

HIV +ve

131
Q

menopause treatment - 3 categories

A

life style
hormone replacement
non hormone replacement

132
Q

lifestyle modifications in menopause

A

Hot flushes
regular exercise, weight loss and reduce stress

Sleep disturbance
avoiding late evening exercise and maintaining good sleep hygiene

Mood
sleep, regular exercise and relaxation

Cognitive symptoms
regular exercise and good sleep hygiene

133
Q

contraindications to HRT

A 
Contraindications: 
Current or past breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
134
Q

How long do the symptoms of menopause usually last?

A

2-5 years

135
Q

Risks with HRT

A

Venous thromboembolism: a slight increase in risk with all forms of oral HRT. No increased risk with transdermal HRT.

Stroke: slightly increased risk with oral oestrogen HRT.

Coronary heart disease: combined HRT may be associated with a slight increase in risk.

Breast cancer: there is an increased risk with all combined
HRT although the risk of dying from breast cancer is not raised.

Ovarian cancer: increased risk with all HRT.

136
Q

Management without HRT in menopause

A

Vasomotor symptoms
fluoxetine, citalopram or venlafaxine

Vaginal dryness
vaginal lubricant or moisturiser

Psychological symptoms
self-help groups, cognitive behaviour therapy or antidepressants

Urogenital symptoms
if suffering from urogenital atrophy vaginal oestrogen can be prescribed. This is appropriate if they are taking HRT or not
vaginal dryness can be treated with moisturisers and lubricants. These can be offered alongside vaginal oestrogens if required.

O&G - C.U (5 decks)

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