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GOSH OSCE > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What is the treatment for a Bartholins gland cyst?

A

Incision and drainage
Broad spectrum antibiotics until cultures
Marsupialisation to prevent recurrence

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2
Q

What is Nabothian cyst?

A

A small mucus filled cyst on the cervix

Squamous epithelium of the ectocervix grows over the columnar epithelium of the endocervix, blocking the cervical crypts.

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3
Q

What is an Ectropion and what causes it?

A

Eversion of columnar endocervix

Driven by oestrogen - normal in young women

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4
Q

What the investigation is the gold standard for diagnosing endometriosis?

A

Laparoscopy

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5
Q

What are the main symptoms of endometriosis?

A

Premenstrual pain
Dysmenorrhea
Deep dyspareunia
Subfertility

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6
Q

Management of endometriosis:

A

Expectant
Medical: NSAIDs
- Hormonal
Surgical: Diathermy

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7
Q

How long is contraception not required for post partum and when is the earliest first ovulation?

A

not required till 21 days

Earliest ovulation in non breast feeding women is 28 days

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8
Q

Options for post partum contraception:

A

Barrier methods - Condoms
POP - start any time
COC - from 21 days if not breast feeding
LARC

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9
Q

Explain LARCs for post partum contraception:

A

IUD - from 28 days
IUS - from 28 days
Progestogen inplant - at any time
Injectable - at any time if not breast feeding

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10
Q

What are the Rotterdam criteria for PCOS?

A

SHOP

String of pearls
Hyperandrogenism
Oligomenorrhae
Prolactin normal

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11
Q

What defines oligomenorrhae?

A

periods occurring at intervals greater than 35 days

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12
Q

What are important differentials to rule out when diagnosing PCOS?

A

Prolactinoma - Prolactin levels
Hypothyroidism - T4 and TSH
Congenital adrenal hyperplasia - 17-hydroxyprogesterone

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13
Q

Investigations for suspected PCOS:

A

Bedside:
Bloods: Serum total and free testosterone
- prolactin, T4, TSH and 17-hydroxyprogesterone
- Fasting glucose, HbA1c and lipids
Imagining: US of ovaries

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14
Q

What are the main 4 causes of secondary amenorrhoea ?

A

Pregnancy
Prolactinoma
PCOS
Premature ovarian insufficiency

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15
Q

What is the pathophysiology behind PCOS?

A

Hypothalamic disturbances lead to basal increases in LH and relative reduction in FSH.
Causes raised androgens and less aromatisation to oestrogens.
Loss of positive feedback - no LH surge - anovulation
Lack of corpus luteum = proliferative endothelium causing heavy, irregular periods

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16
Q

Management of PCOS:

A

All women: Adise on weight loss
Screen for CV risk factors
Annual check of glucose tolerance

Oligomenhorrea - check endometrial thickness
- Induce regular withdrawal bleed with COC

Acne - Topical Benzylperoxide, retinol, antibiotics

Infertility - weightloss and Metformin
- Ovulation induction with clomifene and IVF

17
Q

What are the main presenting complaints of PCOS?

A

Irregular, heavy periods
Subfertility
Acne
Hirsutism

18
Q

What defines primary amenorrhoea?

A

Failure to menstruate by 16 years in the presence of otherwise normal secondary sexual characteristics

19
Q

What defines secondary amenorrhoea?

A

absent periods for 6 months in a normally regular woman

absent periods for 12 months in a irregular woman

20
Q

Investigations for amenorrhoea:

A 
Pregnancy test!
T4 and TSH 
LH and FSH 
Testosterone - androgen secreting tumour
US scan - if abnormal genital tract suspected
21
Q

What might LH and FSH levels tell you when investigating amenorrhoea?

A

If raised = Ovarian insufficiency?
If reduced = Hypothalamic pituitary problem?
If increased LH/FSH ratio = PCOS?

22
Q

What defines sub fertility?

A

Failure to conceive after 12 months of regular unprotected sexual intercourse

Primary if female has never conceived
Secondary if female has conceived previously

23
Q

What are the main 3 causes of sub fertility:

A

Anovulation
Tubal disease
Male factors

24
Q

Causes of anovulation:

A

Hypothalamic - Stress, anorexia
Pituitary - prolactinoma
Ovarian - Insufficiency, PCOS

25
Q

Causes of tubal disease:

A

Pelvic Inflammatory disease (PID)
Endometriosis
Surgical adhesions

26
Q

Investigations for suspected tubal disease to assess patency:

A

Hysterosalpingogram “fill and spill”

Laparoscopy and dye test - if you suspect surgery may be needed

27
Q

Investigations for a subfertile couple:

A

Bedside: Semen analysis

Bloods: Prolactin

  • LH and FSH
  • T4 and TSH
  • Oestrogen and Testosterone
  • Progesterone - 7 days after ovulation

Imaging: Hysterosalpingogram
Special: Laparocopy and dye

28
Q

Council on lifestyle advice for subfertile couple:

A 
Weight loss if overweight 
Smoking cessation 
Reduce caffeine intake
Reduce alcohol intake 
Have intercourse 2 -3 times a week 
Timing during cycle is not recommended
29
Q

What is as an early pregnancy loss and what is miscarriage?

A

Loss within the first 12 weeks

Miscarriage up to 24 weeks

30
Q

What are the types of miscarriage and the status of the cervical Os in each:

A 
Threatened - Closed
Inevitable - Open
Incomplete - Open
Delayed - Closed but no foetal heart beat 
Complete - Closed
31
Q

Investigations for bleeding in early pregnancy:

A

Bloods: FBC, Group and rhesus status
Imaging: Trans Vaginal Ultrasound

32
Q

Management of retained products of conception:

A

Give Anti-D if rhesus negative

Expectant management
Medical: Misoprostol
Surgical evacuation

33
Q

What are the risks of surgical evacuation of retained products of contraception:

A

Cervical damage
Uterine perforation
Infection
Failure - re evacuation required

34
Q

Counsel post miscarriage:

A

Reassure - 1 in 5 pregnancies end in miscarriage
Nothing you have done wrong
Miscarriage association for support
Wait for one period before trying again when feel ready
Emphasise most likely successful next time
Folic acid, Healthy diet, Smoking cessation

35
Q

Investigation for pregnancy of unknown location on transvaginal ultrasound:

A

Serum hCG at 0 and 48hours

Increase > 63% = early intrauterine pregnancy
- repeat transvaginal US in 7-14 days

Suboptimal rise/fall = Ectopic
- Clinical review within 24 hours

hCG decrease >50% = Failing pregnancy
- Urine pregnancy test in 2 weeks

36
Q

What triad of symptoms do ectopics usually present with?

A

Amenorrhea
Pain
PV Bleeding

37
Q

Above what serum level of hCG would you expect to see an intrauterine pregnancy on a TVUS?

A

1500iu

38
Q

Management of ectopic:

A

Expectant - if failing
Medical - Methotrexate - if stable and hCG <5000iu
Surgical - Laparoscopic salpingectomy

Need to be followed up next pregnancy
See in EPAU at 6 weeks for assessment and US

39
Q

Risk factors for ectopic:

A

PIPPA

Previous ectopic
Intrauterine contraceptive
Pelvic inflammatory disease
Pelvic or tubal surgery 
Assisted reproduction

GOSH OSCE (2 decks)

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