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MURMURS > gynaecology > Flashcards

gynaecology Flashcards

1
Q

how can vulcal cancer present

A

as lichen sclerosis and atrophius with fusion of the labia

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2
Q

Bartholins cyst explain

A

A subcutaeous pea sized deep in the lower third of labia produces mucus to lubricate the vulva and vagina and drains into the vestibule within the hymen and labia minora cyst forms when the duct gets blocked - at 5oclock and 7 o clock region

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3
Q

bartholins abscess

A

women in 20’s tender swelling of labia with erythema opportunist infections by vulval flora mixed anaerobic and aerobic growth commonly e coli stre and staph and prteus not STI!!!!!

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4
Q

Bartholins abscesss treatment

A

incision and drainage broad spec abx - amox and cefalexin can have marsupoalisation to keep the opening of cyst open

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5
Q

What it nabothian cyst

A

small mucus filled cyst in the surface of the cervix it is squamous and grows over the columnar epithelium of the endocervis blocking the cervical crypts and is absolutely normal

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6
Q

What is ectropian?

A

everted columar epithelium when the cells inside of the womb protrude out to the neck of the womb. It is oestrogen dependent and the pill COCP causes it

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7
Q

endometriosis pathophysiology

A

retrograde menstruation which thickens cyclically causing pain worse pre menstrually at the onset of the period frozen pelvis - scaring and adhesions which look grey/ white
depsotis occur in the ovaries caused chocolate cycts

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8
Q

symptoms of endometriosis

A

pre menstrual dysmenhorrea deep dysparenuria chronic pelvic pain

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9
Q

hwo is the uterus in endometriosis

A

retroverted

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10
Q

Diagnosis of endometriosis

A

confirmed by biopsy ca125 levels may be raised due to periotneal involvement but not a useful diagnostic tool

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11
Q

managment of endometriosis

A
  1. expectant - asymptomatic women with mild disease
  2. symptoms relif - analegesia
  3. Prevent hormonal stimulation of ectopic endometrium so inhibit ovarian hormone prodection - progestrogents , COCP, IUS, GnRh create temporary menopause and
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12
Q

Surgical treatment of endometriosis

A

diathermy or laser and excision

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13
Q

34y/o cyclical pelvic pain and deep dysparenuria parter and her trying to concieve for the last two years diagnositc laparoscopy reveals endometrial depostis and tubo ovarian adhesions

A

surgical mangement- she wishes to concieve and nothing will help her as much as surgery to insure adhesiosn are not blocking her. surgery may remove symptomatic relif anf improve chances of conception

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14
Q

17 y/O cyclic pelvic pain and deep dysparenuria has a boyfriend but no wish to concieve at present takes paracetamol and diclofenac with minimal effect diagnostic laposcopy demonstrates small amounts of endometriosis on the uterosacral ligaments

A

medical simple analgesics have helped so as ther endo is mild med option should be tried with COCP which can provide contraception too and surgical optiosn should be reserved for cases where med managment has failed or fertility is desired and she be carefully ocnsidered in someone so young

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15
Q

37 y/o undergone laparoscopic tubal sterilisation at the time of the sterilisation spots of endometroisi were found on the uterosacral ligaments in the pouch of douglas and on the obaries - denies any pelvis pain

A

no treatment needed mild eno which is aymptomatic - if symptomatic it would present with pain and subfertility in servere cases inflammation and fibrosis can lead to a frozen pelvis

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16
Q

why do you not want to start COC on patient from day 21 if are BREASTFEEDING

A

oestrogen may inhibit lactation

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17
Q

LH:FSH ratio in PCOS AND OESTORGEN

A

LH inc but only to a basal there is no surgery therefore the egg is never relevease and remains in ovaries to form cysts. with dec FSH oestrogen will be dec

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18
Q

symptoms of PCOS

A
  1. Acne and hirtism - Inc androgens
  2. Subfertility - anovulation
  3. heavy irrgeular bleeding - Lack of adequate luteal phase proliferaltive endometrium
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19
Q

USS of a PCOS

A

STRONGS OF PEARLS

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20
Q

Rotterdam criteria in PCOS

A

Summarises the many features of PCOS
S - Strings of pearls
H - hyperandrogenism(too much teststosterone) acne hirtis
O - oligomenhorrea - period at intervals > 35 days
P - prolactin normal

prolactin t4 and cortisol need to be normal and the first two are deffo needed for a diagnosis but this method is flawed as it does not tkaae into consideration the insulin resistance present in many people

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21
Q

blood tests for pcos

A

day 21 progestrogen, total or free testosterone , fasting glucose adnd lits to seei nsulin resistance
Procating T4 and TSH to see prolactinoma and hypothyroidism

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22
Q

How do you exclude congenital adrenal hyperplasia

A

17-hydroxyprogesterone measure

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23
Q

secondary amehorrea causes (4p’s)

A

PCOS Premature ovarian insufficentcy, prolactinoma, Pregnancy

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24
Q

management in pcos

A

is dependent on the clinical presentation

  1. weight loss
  2. acne - benzoyl peroxide and or Abx
  3. oligomenhorrea - check endo thickness and induce withdrawal bleed with progrestrogen or COC
  4. Infertility- weight loss, metformin, ovulation with clomifen IVF with gonadotrophins
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25
Q

What does clomifen do ?

A

blocks oestrogen recpetors at hypothalmus and pitutary to prevent negative feedback and lead to inc FSH stimulation folicular development

26
Q

SE of clomifen

A

ovarian hyperstimulation where the ovary increases in sizze and multiple follicles release vegf causing ascities and if severe systemic reaction with shock

27
Q

primary amenhorrea and secondary amenhorrea definition

A

primary is failure of menstruation by 16 years with otherwise normal sextual characteristics
Secondary is absent periods for 6 motnhs in a women who had previously regular periods or 12 months in women with irregular periods

28
Q

Causes of amenhorrea

A

PREGNANCYYYYY!!!!!!!!!!!!!!
Hypothalamic - GnRH defisincey
Pituitary tumour- hyperprolactinoma inhibiting ovulation c pituitary necrosis in (sheehan syndrome)
Ovarian- PCOS premature ovarian insufficentcy
Outflow probs - imperforate hymen , cervical stenosis absent uterus (rokitansky !!!)

29
Q

Investigations for amenhorrea

A
  1. pregnancy test
  2. thyroid function - hyper hypo inhibits ovulation
  3. LH/FSH 0 raised =ovarian insifficentcy
    reduced = hypothalamic/pit problem
    increased = FSH/LH
    Testosterone - exclude androgen secreting tumour USS if abnormal gential tract suspected
30
Q

treament of gonadotrophin insufficientcy

A

replace them if fertility desired if not COCP

31
Q

pcos treatmenet

A

wl ,metformin /ovulation induction if fertility desired

wl cocp if fertility not desired

32
Q

ovarian insifficentcy treatment

A

no treatment but COCP and HRT may improve symptoms eff donantion if fertiltiy desired

33
Q

Gential treat abnormality treatment

A

outflow obstruction then its urgical

Tokitansky -no treatment surrogagcy

34
Q

Chylamidia signs

A

dysuria and discharge intementsrual and post coital bleeding ascending infection acute salpingitis or PID

On hisotoly there will be elementsry bodies which become reticulocyte bodies which produces discharge

35
Q

THE SWABS to use for this in female

A

the bacteria enters the endocervix in women therefore that needs to be endocervical swab

36
Q

treatment of chylamidia

A

antibiotics oral doxycycline 100mg BD for 7 days erythromycin in pregnancy gonoccocu co infection then azihtromycin and ceftriazone SEX in trichomonas ?

37
Q

Signs and symptoms of PID

A

typically bilateral deep dysparenuria vaginal discharge and abnormal vaginal bleeding

38
Q

Cuae of PID

A

mixture of organism as the travel up the genital tract

39
Q

Acute PID/SALPINGITIS symptoms

A

low abdo tenderness, fever, cervisitits cervical motion tenderness and adenexal tenderness

40
Q

investigation in acute PID / salpingitis

A

FBC CRP triple swabs pelvic USS or laparoscopy if uncertain

41
Q

Treatment of PId/ SALPINGITIS

A

ceftriaxone then oral doxycycline metronidazole for 14 days if fever unwell pertonism admit for IV therapy

42
Q

Subfertility

How long do you need to try for at least

A

a failure to concieve after 12 months regular unprotected intercourse primary female partner never conceived sexondary female partner has conceived

2 years

43
Q

commonest cause of subferitlity

A

annovulation can be due to hypothalamopituitary acis

44
Q

hypthalamic causes of annovulation

A

stress anorexia

45
Q

anti pit causes of annovulation

A

prolactinoma

46
Q

ovarian causes of annovulation

A

PCOS or premature ovarian insifficentcy (D21 confirms ovulation)

47
Q

How do you address tubal patency

A

with a hysterosapingogram where you fill and spill or a lapaoscopy and dye

48
Q

male factor subfertiltiy and investigation

A

Azospermia- absent spermatozoa
few spemaozoa - oligospermia
excess or abnormal sperm - teratozoospermia
a significant proportion of immotile sperm asthenozoospermia

semen analysis count>15million motility >40% and forms of sperm >4

49
Q

Treatment for subferitlity

A

conservative - weightloss smoking cessation refuce caffeine and alcohol intake and intercorurse 2-3 times a week timing cycyle not recommended as it creates stress

medical treatment - annovulation - comifene gonadoptrophines GNRH with or without asisted reporduction

50
Q

treamtent presmature ovarian insufficiency subferiltiy

A

egg donation and iVF

51
Q

Tubal damage IVF

A

tubal surgery or IVF

52
Q

MALE FACTOR TREATMENT

A

asisted reporduction

53
Q

The three asisted repro techniques

A
  1. intrauterine insemination - good for azospermia can select the fast sperm
  2. in vitrofertilidation
  3. intracytoplasmic sperm injections - single sperm into a single egg good for oligospermia
54
Q

Difference betwen miscarrigae early preganacy loss and premature preterm labour

A

miscarrigae - >24 weeks
early preganancy loss <12 weeeks
early premetm labour is give steorids and its after 24 weeks

55
Q

the imporance of uss in a miscarrigae

A

confirms location of the pregnancy femosntratess fetal heart rate on uss an is associated with a sucessful pregnancy and visualise the adenexa - for ectopics too

56
Q

investigations in miscarrigae

A

FBC blood group and antibosy and rhesus status

57
Q

three types of managment for a miscarriage

A

FIRST CONFIRM DIAGNOSIS WITH USS
1. expectant wait and see - first line and resolution takes wks
Explore other options if at increased risk of bleeding adverse exp of pregnancy or women prefers :
2. medical - vaginal prostaglafin misoprostolol
3. surgical - evaculation of retained products of conception
4. give anti d if rhesus negative

58
Q

how to investigate a pregnancy of unknown origin on transvaginal uss

A
  1. will have done a TVUSS first
  2. HCG measure it
    1500> = increased = intrauterine preganancy likely but its probs so early cant be seen on USS repeat in 7-14 dys
    Suboptimal increase = ectopic pregnancy - clincial review within 24 hrs - look for this it should double every 2 days in early prehgnancy !!!
    decreased = falling preganancy do a pregnancy test in two weeks
59
Q

RF FOR ECTOPIC

and the three symptoms

A 
P = Previous ectopic
I = intrauterine contraceptive device 
P = prelvic inflammatory disease 
P = pelvic or tubal surgery
A = assisted repro

bleeding amenhorrea and pain

60
Q

pelvic exam of a ectopic

A

cervical motion tenderness

uterine size does it match gestation

61
Q

how does molar prgegnancy present

A

vaginal bleeding in fisrt trimester with all symptoms of prhganncy exaggerated high HCG and hyperemesis gravidum

MURMURS (16 decks)

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