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Year 4 Obs and Gynae > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What is the purpose of normal menstruation?

A

produce oocyte, facilitate fertilisation and optimise endometrium for implantation

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2
Q

What are the names of your first and last period?

A

menarche and menopause

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3
Q

What are the hormonal changes in the follicular/proliferative phase?

A 
FSH high (mature follicle)
Oestrogen causes proliferation
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4
Q

What hormone change causes ovulation?

A

LH surge

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5
Q

What produces progesterone in the luteal/proliferative phase of menstruation?

A

Corpus luteum

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6
Q

What affect does progesterone have on the endometrium during the luteal phase of the menstrual cycle?

A

stabilised endometrium and makes it secretory

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7
Q

Where is GnRH produced?

A

Hypothalomus

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8
Q

GnRH secretion can be affected by what?

A

stress
time zone
weight loss
anxiety

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9
Q

Where does GnRH produce a response and what is released?

A

anterior pituitary which stimulates production of FSH and LH

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10
Q

What is the function of FSH?

A

stimulates follicular activity and promotes estradiol production

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11
Q

What is the function of LH?

A

triggers release of egg from follicle, promotoes development of corpus luteum and production of progesterone

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12
Q

Where to FSH and LH trigger the production of oestrogen and progesterone?

A

ovaries

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13
Q

If there is no fertilisation of an egg, what happens to the corpus luteum?

A

degenerates becoming the corupus albicans –> drop in progesterone levels leading to endometrial shedding

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14
Q

Describe the endometrium during the follicular/proliferative phase?

A

thickens, increased glands and blood vessels

thickness 2-3mm

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15
Q

Describe the endometrium curing the secretory/luteal phase?

A

increased secretions, lipids, glycogen and blood supply

4-6mm thick

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16
Q

Define primary dysmneorrhoea

A

painful periods with no underlying pelvis pathology

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17
Q

What is the difference between primary and secondary amenorrhoea?

A

primary - never started periods

secondary - absence of periods after >6 months menarche

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18
Q

What are some common causes of oligomenorrhoea?

A 
PCOS
contraceptive methods
perimenopause
thyroid disease
DM
eating disorders
medications
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19
Q

What is the acoronym for for causes of abnormal bleeding (and what are the causes)?

A

PALM (structural) COEIN (non-structural)

  • polyp
  • adenoymyosis
  • leiomyoma (fibroids)
  • malignancy
  • coagulopathy
  • ovulatory dysfunction
  • endometrial
  • iatrogenic
  • not yet classified
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20
Q

What investigations are important to perform in someone with heavy menstrual bleeding?

A 
PT
USS
Bloods - FBC (anaemia), TFTs, hormonal screen, coagluopathy/clotting screen
smear up to date??
hysteroscopy +/- biopsy
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21
Q

Which out of IMB and PCB is more likely to be endometrial or cervical problems?

A

IMB - endometrial
PCB - cervical
(more likely causes, but not always)

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22
Q

What are some cervical causes of abnormal bleeding?

A

infection (chlamydia/gonorrhoea)
cervical polyp
cervical ectropion

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23
Q

What are some endometrial causes of abnormal bleeding?

A

fibroid
endometrial polyp
malignant/pre-malignant
endometriosis

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24
Q

What are the genera hormonal treatments that may be of use in abnormal menstrual bleeding?

A

COCP, POP, mirena coil

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25
Q

What are the general non-hormonal treatments that may be of use in abnormal menstrual bleeding?

A

tranexsamic acid and mefanamic acid

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26
Q

What is premenstrual syndrome?

A

distressing, psychological, physical and/or behavioural symptoms occuring in the luteal phase of the menstrual cycle

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27
Q

What percentage of women experience no symptoms from PMS?

A

15%

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28
Q

What are the hormonal abnormalities in PCOS?

A

Essentially always in follicular phase (where oestrogen predominates) therefore consistently high levels of oestrogen
High levels of LH, which never reach a surge (no ovulation)
insulin resistance

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29
Q

What are the signs and symptoms of PCOS?

A 
infertility
amenorrhoea/oligomenorrhoea
acne
hirsutism
obesity
chronic pelvic pain
depression
30
Q

What are the Rotterdam criteria?

A

Diagnosis of PCOS with 2 out of 3:

  • oligo- or an-ovulation
  • clinical or biochemical signs of hyperandrogenism
  • polycystic ovaries on scan
31
Q

What is the management of PCOS?

A

stabilise menses (COCP)
council on obesity
metformin (for insulin resistance)
Eflornithine (cream to reduce hair growth)
Clomifene (helps fertility)
Gonadotrophin injections (FSH/LH) but can lead to ovarian hyperstimulation syndrome (OHSS)

32
Q

Suggest some gynaecological and non-gynaecological causes of ACUTE PELVIC PAIN

A

GYNAE:

  • ectopic pregnancy
  • ovarian cyst accident
  • primary dysmenorrhoea

NON-GYNAE:

  • appendicitis
  • IBS/IBD
  • strangulated hernia
  • UTI
33
Q

Suggest some gynaecological and non-gynaecological causes of CHRONIC PELVIC PAIN

A

GYNAE:

  • PID
  • pelvic adhesion
  • Asherman’s syndrome
  • Dysmenorrhoea

NON-GYNAE:

  • constipation
  • IBS/IBD
  • Hernia
  • interstitial cystitis
34
Q

When can you diagnose menopause?

A

12 months after LMP

35
Q

What hormonal changes occur in menopause?

A

Rise in FSH (and LH) due to falling oestrogen levels (no negative feedback loop)

36
Q

What are some early symptoms of menopause?

A 
vasomotor
period changing
insomnia
mood swings
cognitive function impairment
thinning of skin and hair
joints and muscle aches
fat redistribution
37
Q

What are some longer term symptoms of menopause?

A

vaginal dryness
bladder changes (frequency, urgency, UTIs)
osteoporosis
increased risk of cardiovascular disaese

38
Q

What treatment can be offered for menopause?

A

explanation
diet and lifestyle advice
HRT (discuss pros and cons)
Non-hormonal alternatives

39
Q

What is endometriosis?

A

chronic condition where endometrial tissue lies outside of the uterine cavity

40
Q

What is adenomyosis?

A

Endometriosis where the ectopic tissue is in the myometrium

41
Q

What are risk factors associated with endometriosis?

A 
early menarche
FHx
short menstrual cycles
long duration of menstrual bleeding
heavy menstrual bleeding
defects in uterus/tubes
42
Q

What are the symptoms of endometriosis?

A 
cyclical pelvic pain
subfertility
dysmenorrhoea
dyschezia
dyspareunia
dysuria
may get more localised symptoms depending on site
43
Q

What signs would be present on bimanual examination of someone with endometriosis?

A

fixed retrograde uterus
uterosacral ligament nodes
general tenderness

44
Q

What investigations are used to assess/diagnose endometriosis?

A

laparoscopy (gold standard)

pelvis USS

45
Q

What findings on laparoscopy are indicative of endometriosis?

A

chocolate cysts
adhesions
peritoneal deposits

46
Q

What is the management of endometriosis?

A

NSAIDs (for pain)
COCP/mirena (suppress ovulation for 6-12 months -> can cause atrophy of ectopic tissue)
GnRH analogues (chemically induce menopause)
laser ablation or hysterectomy (only if extreme)

47
Q

What is pelvis inflammatory disease?

A

chronic pelvic pain due to upward tracking of infection of vagina/cervix leading to inflammation of the uterus, fallopian tubes and ovaries

48
Q

What are the most common causes of PID?

A

chlamydia trachomatis
neisseria gonorrhoea
streptococcus

49
Q

What percentage of PID is caused by STIs?

A

25%

50
Q

What are the clinical criteria for diagnosing PID?

A 
lower abdo pain +
one of (pyrexia >38/leucocytosis/ESR>15) +
one of (adnexal pain/cervical motion tenderness/adnexal mass)
51
Q

What are risk factors associated with PID?

A 
sexually active 
age 16-24
recent partner change 
unprotected sex
history of STIs
52
Q

What are the symptoms of PID?

A 
lower abdo pain (often bilateral)
deep dyspareunia
menstrual abnormalities
post-coital bleeding
dysuria
abnormal vaginal discharge
possible fever
53
Q

What signs would present on vaginal examination in someone with PID?

A

tender uterus/adnexae
cervical motion tenderness
palpable mass
mucopurulent discharge

54
Q

What investigations would you do in someone with suspected PID?

A 
Full STI screen inc. swabs (VVS, HVS)
pregnancy test
urine dip
TV USS
laparoscopy
55
Q

What is the management for PID?

A 
14 days broad spec abx (doxycycline, ceftriaxone or metronidazole)
avoid sexual intercourse until abx complete (in both partners)
analgesia
hospital admission if:
-risk of ectopic
-severe symptoms
-signs of pelvic peritonitis
-unresponsive to oral abs
-need for emergency surgery
56
Q

What are some complications of PID?

A 
ectopic pregnancy
infertility (1 in 10 with PID)
tubo-ovarian abscess
chronic pelvic pain
Fitz-Hugh-Curtis syndrome (per-hepatitis)
57
Q

Define miscarriage

A

loss of pregnancy before 24wks

58
Q

What is the definition of early and late miscarriages?

A

early - up to 13wks

late - 13-24wks

59
Q

What is a threatened miscarriage?

A

symptoms of miscarriage (pain and bleeding) but pregnancy still viable on USS

60
Q

What is a missed miscarriage?

A

no symptoms of miscarriage but pregnancy found to have terminated on USS

61
Q

What is an incomplete miscarriage?

A

Some of the symptoms of miscarriage but some retained POC on USS

62
Q

What is a complete miscarriage?

A

severe symptoms (pain and bleeding) of miscarriage and uterus completely empty on USS

63
Q

What risk factors are associated with miscarriage?

A 
maternal age >35
previous miscarriage
obesity
chromosomal abnormalities
smoking
uterine anomalies
previous uterine surgery
anti-phospholipid syndrome
coagulopathies
64
Q

What investigations should be performed with a suspected miscarriage?

A

PT
TV USS - assess for fetal cardiac activity
serum bHCG - serial testing to differentiate between ectopic
assess bleeding - FBC, rhesus status, CRP

65
Q

What is the management of miscarriage?

A

For anyone rhesus -ve >12 wks –> anti-D prophylaxis

Conservative ‘watchful waiting’:

  • allows POC to pass naturally
  • if unsuccessful, will need intervention
  • follow-up: repeat scan and PT 3wks later
  • contraindicated if infection or high risk of haemorrhage

Medical:

  • use vaginal misoprostol to stimulate cervical ripening and contraction - may be preceded by mifipristone
  • SE of meds (N&V and diarrhoea)
  • follow up: scan and PT 3wks later

Surgical:

  • manual vacuum aspiration with local anaesthetic <12wks
  • evacuation of retained POC under GA if >12wks
  • necessary if haemodynamically unstable
  • associated with surgical risks
66
Q

What is an ectopic pregnancy?

A

pregnancy implanted anywhere outside of uterine cavity

67
Q

Where is the most common site of ectopic pregnancy?

A

ampulla of fallopian tube

68
Q

What risk factors are associated with ectopic pregnancy?

A
  • previous ectopic
  • PID
  • endometriosis
  • IUD/IUS, POP, tubal ligation
  • previous pelvic surgery
  • IVF
69
Q

What is the presentation of ectopic pregnancy?

A

PAIN - lower abdo/pelvic with assoc shoulder tip pain
brownish vaginal discharge
?PV bleeding with history of amenorrhoea

70
Q

How would you investigate suspected ectopic pregnancy?

A

-PT - if +ve, pelvic USS/TV USS
-if nothing seen on USS but PT +ve = PREGNANCY OF UNKNOWN LOCATION
-serum bHCG
>1500 = ectopic until proven otherwise
<1500 - repeat after 48 hrs
if increasing lots = v early normal pregnancy
if decreasing lots = miscarriage
if relatively stable = ectopic

71
Q

What is the management of ectopic pregnancy?

A

if clinically unstable, A-E

Conservative:

  • allow ectopic to resolve naturally
  • only if patient very stable
  • monitor bHCG every 48hrs
  • may rupture if wait too long

Medical:

  • IM methotrexate
  • monitor bHCG (may need repeat dose)
  • SEs: abdo pain, myelosuppression, v teratogenic (no unprotected sex for 3 mnths)

Surgical:

  • laparoscopic salpingectomy (for tubal ectopic)
  • bHCG levels after surgery
  • definite cure

Year 4 Obs and Gynae (2 decks)

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